Effects of Extracorporeal Shock Wave Therapy on Fracture Nonunions

The purpose of this study was to examine the effect of focused extracorporeal shock wave therapy (ESWT) on the treatment of nonunions. As part of a prospective study, we included 143 patients (average age, 41.4 years) with a diagnosis of nonunion (mean, 14.1 months; range, 6-84 months). High-energy shock wave treatment was applied using electromagnetic shock wave generators. The shock waves were applied in 3-5 sessions of 2500 to 3000 impulses each given at 0.25-0.84 mJ/mm2, at intervals of 48-72 hours between sessions. A maximum of 3 cycles of treatment was given, at 3-month intervals. The patients were followed during a 12-month period until fracture healing or, in case of failure, until another therapy was adopted. Complete healing was observed in 80 of 143 cases (55.9%) at an average time of 7.6 months (range, 2-24 months). Partial healing occurred in 41 cases (28.7%) and no healing was observed in 22 cases (15.4%). Patients with trophic nonunions had a better success rate than patients with atrophic nonunions (P<.05). The results show ESWT is a safe and effective treatment for nonunions. ESWT is more effective for trophic nonunions than atrophic nonunions.