• DOI:10.2106/JBJS.H.00841
• Corpus ID: 14781802

Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions.

@article{Cacchio2009ExtracorporealST,
  title={Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions.},
  author={Angelo Cacchio and Lucio Giordano and Olivo Colafarina and Jan Dirk Rompe and Emanuela Tavernese and Francesco Ioppolo and Stefano Flamini and Giorgio Spacca and Valter Santilli},
  journal={The Journal of bone and joint surgery. American volume},
  year={2009},
  volume={91 11},
  pages={
          2589-97
        }
}

• A. Cacchio, L. Giordano, +6 authors V. Santilli
• Published 1 November 2009
• Medicine
• The Journal of bone and joint surgery. American volume

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/mm(2) (Group 1) or 0.70 mJ/mm(2) (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 hypertrophic nonunions and yields better short-term clinical outcomes.