Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions

Cacchio, Angelo; Giordano, Lucio; Colafarina, Olivo; Rompe, Jan D.; Tavernese, Emanuela; Ioppolo, Francesco; Flamini, Stefano; Spacca, Giorgio; Santilli, Valter
November 2009
Journal of Bone & Joint Surgery, American Volume;Nov2009, Vol. 91-A Issue 11, p2589
Academic Journal
Background: The authors of several studies have recommended extracorporeal shock-wave therapy as an alternative to surgical treatment for long-bone nonunions. This study was performed to compare the results of extracorporeal shock-wave therapy produced by two different devices with those of surgical treatment in the management of long-bone nonunions. Methods: One hundred and twenty-six patients with a long-bone nonunion were randomly assigned to receive either extracorporeal shock-wave therapy (Groups 1 and 2) or surgical treatment (Group 3). The patients in the shock-wave groups received four treatments with 4000 impulses of shock waves with an energy flux density of 0.40 mJ/mm² (Group 1) or 0.70 mJ/mm² (Group 2). The patients in the three groups had similar demographic characteristics, durations of nonunion, and durations of follow-up. Radiographic results (the primary outcome) and clinical results (the secondary outcomes) were determined before and three, six, twelve, and twenty-four months after treatment. Results: The radiographic findings did not differ among the three groups of patients. At six months, 70% of the nonunions in Group 1, 71% of the nonunions in Group 2, and 73% of the nonunions in Group 3 had healed. Three and six months after treatment, the clinical outcomes in the two shock-wave groups were significantly better than those in the surgical group (p < 0.001). However, at both twelve and twenty-four months after treatment, there were no differences among the three groups, with the exception of the DASH score, which differed significantly between Groups 1 and 3 (p = 0.038) and between Groups 2 and 3 (p = 0.021) at twelve months. Conclusions: Extracorporeal shock-wave therapy is as effective as surgery in stimulating union of long-bone hyper- trophic nonunions and yields better short-term clinical outcomes. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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