Since approximately 15 years extracorporeal shock wave treatment (ESWT) is successfully used for the treatment of non-healing fractures in special centers worldwide (Europe, Asia, Africa and off-label also in the USA). After extensive basic research and positively conducted clinical trials the executive committee of the 14th Congress of the International Society for Extracorporel Shockwave Treatment (ISMST) held in June in Kiel, Germany decided to recommend
ESWT for the treatment of long bone non-unions as therapy of “first choice”
Ludger Gerdesmeyer, President of ISMST: “Shockwave is as effective as surgical intervention in healing long bone non-unions, but non operative, bloodless and less burdening for patients, and - in the final analysis – saves money for the health care system.”
Shock wave therapy reduces suffering and recovery time
Applying shock wave therapy saves the patients not only from elaborate surgery (extensive dissection of the non-union, removing scar tissue through milling and chiseling as well as bone transplants, mostly from the pelvic bone), but also from long hospital stays and possible following complications. While after surgery 10 to 30% of the cases develop more or less serious complications, with shock wave treatment only minor side-effects, if any, were observed (superficial swellings and superficial hematomas with no clinical impact). The first randomized controlled trial* (RCT) comparing surgical therapy to shockwave treatment for pseudarthrosis of long bones published in the world leading U.S. Journal of Bone & Joint Surgery (JBJS) proved:
1. ESWT and surgery show practically the same success rates
2. Recovery was significantly accelerated in the patients receiving ESWT
3. Complications were significantly reduced in the patients receiving ESWT
The same outcome has a second study** recently published in JBJS by John Furia, a leading U.S. orthopedic surgeon and specialist for sports medicine: The investigation showed similar results comparing ESWT to surgery in patients suffering from a non-union of their fifth metatarsal bone (Jone´s fracture) occurring frequently in physically active patients and high profile athletes.
*Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions
A. Cacchio, L. Giordano, O. Colafarina, J. D. Rompe, E. Tavernese, F. Ioppolo, S. Flamini, G.Spacca,and V. Santilli. J Bone Joint Surg Am. 91:2589–97, Nov 2009
**Shock Wave Therapy Compared with Intramedullary Screw Fixation for Nonunion of Proximal Fifth Metatarsal Metaphyseal-Diaphyseal Fractures
John P. Furia, Paul J. Juliano, Allison M. Wade, Wolfgang Schaden and Rainer Mittermayr
J Bone Joint Surg Am. 92:846-854. April 2010
Shock wave therapy is practically complication free and reduces healthcare costs
(by about 80 %)
Since December 1998, close to 3000 patients with non-unions were treated with shock wave therapy at the AUVA Trauma Center Meidling in Vienna, Austria where ESWT is recognized as therapy of “first choice” for non-unions since August, 2000. Approximately 80% of the patients, who were referred from more than 90 hospitals and clinics from all over Austria and its neighboring countries as well in some cases even from overseas, were completely cured by this non-invasive, practically side-effect free method.
By fastidious collection and evaluation of treatment data it could be shown that besides negligible side effects (superficial swellings and hematomas with no clinical impact) applying shock wave treatment for non-unions reduces costs the health care systems by about 80 %.
Ludger Gerdesmeyer: “It is hard to understand that only very few patients suffering from non healing fractures still do not get the option for such an effective treatment. Still hundreds of millions of Euros are wasted European wide by neglecting shockwave therapy.”