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Shock-wave therapy as good as surgery for long-bone nonunions

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – New research suggests that extracorporeal shock-wave therapy (ESWT) is a viable alternative to surgery for long-bone hypertrophic nonunions.

“When we examined patients and compared their outcomes at 3 and 6 months, initially those who received ESWT actually felt better than those who had surgery,” lead author Dr. Angelo Cacchio said in a statement. “When we examined patients at 12 and 24 months, there were not significant differences in terms of healing.”

The findings, reported in The Journal of Bone and Joint Surgery for November, stem from a study of 126 patients who were randomized to undergo surgery or to receive four ESWT treatments at one of two energy flux densities (0.40 or 0.70 mJ/millimeters-squared). The main outcome measure was fracture healing assessed with radiography.

At 6 months, the percentage of patients with healed fractures in each group was nearly the same, hovering closely around 71%, Dr. Cacchio, from San Salvatore Hospital of L’Aquila, Italy, and associates report.

At both 3 and 6 months, pain and function scores were significantly better in the ESWT groups than in the surgical group. By 12 months, the differences had largely disappeared with the exception of the ESWT groups continuing to have better scores on the Disabilities of the Arm, Shoulder, and Hand questionnaire.

“The results of this randomized controlled trial strongly suggest that ESWT is a simple and safe alternative to surgical treatment of hypertrophic long-bone nonunions,” the authors conclude.

However, they add, the findings need to be verified, and “different treatment protocols as well as treatment parameters should be investigated; these include the number of shock waves used, the energy levels applied and the frequency of application.”

Reference:
J Bone Joint Surg 2009.