Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

Abstract

Background Long-bone non-unions after intramedullary nailing can be treated by nail dynamization or focused high-energy extracorporal shock wave therapy (fESWT). The objective of this study was to assess the effect of the combination therapy of nail dynamization and fESWT on long-bone non-unions. Materials and methods 49 patients with long-bone non-unions (femur and tibia) after nailing were treated with nail dynamization (group D, n = 15), fESWT (group S, n = 17) or nail dynamization in addition to fESWT (group DS, n = 17). Patients were followed up for 6 months retrospectively. Furthermore, age, sex, Non-Union Scoring System (NUSS) score, time intervals from primary and last surgery until intervention and smoking status were analysed for their correlations to bone union. Results Union rates were 60% for group D, 64.7% for group S and 88.2% for group DS, with a significant difference between group D and DS (p = 0.024). Successful treatment was correlated with high age (OR 1.131; 95% CI 1.009–1.268; p = 0.034), female gender (OR 0.009; 95% CI 0.000–0.89; p = 0.039), low NUSS score (OR 0.839; 95% CI 0.717–0.081; p = 0.028) and negative smoking status (OR 86.018; 95% CI 3.051–2425.038; p = 0.009). Conclusions Data from the present study indicate that the combination therapy of nail dynamization and fESWT leads to a higher union rate than dynamization or fESWT alone. Level of evidence Level 3.

Clinical Results of Decortication with Bone Grafting Method versus Extracorporeal Shock Wave Treatment in Long-Bone Pseudoarthrosis

“…Alvarez performed ESWT in 34 fractures in 32 metatarsal non-union patients at an average of 23 weeks after injury and reported the bone union rate as 89% after an average follow-up of 1 year [ 21 ]. Josef et al performed ESWT in 17 long-bone (tibia-femur) pseudoarthrosis patients and had a bone union rate of 64.7% [ 22 ]. Zelle reported had a 76% bone union rate, which was higher in the hypertrophic pseudoarthrosis in the 10 studies including 924 delayed unions treated with ESWT they reviewed to assess the efficacy of ESWT [ 23 ].…”

Biophysical Enhancement in Fracture Healing: A Review of the Literature

“…This, in turn, creates hematoma formation, cell death, and bone formation (Table 4) [75]. The review of the literature shows that ultrasounds could have a beneficial effect on the healing of fractures [75][76][77][78][79][80][81][82][83][84][85][86]. A study compares patients with delayed unions after long bone fixation, and the authors, by the application of nails, achieved a union rate of 60%.…”

“…A study compares patients with delayed unions after long bone fixation, and the authors, by the application of nails, achieved a union rate of 60%. In comparison, in another group, they chose a combination of dynamization and ultrasound, and the union rate increased to 88% [ 85 ]. The application of shockwave ultrasound to fractures is necessary to be performed in an operating room under fluoroscopic control, and patients should be required to undergo general or regional anesthesia.…”

Fixators dynamization for delayed union and non-union of femur and tibial fractures: a review of techniques, timing and influence factors

“…The technique of intramedullary nail dynamization is well-established and widely used in clinical practice due to its simplicity [28,[69][70][71][72][73][74][75][76]. However, the effectiveness of intramedullary nail dynamization in treating bone healing disorders has been reported with conflicting results in various studies (Additional file 1: Table S1).…”

“…The NUSS score could theoretically help predict which bone disorders could benefit more from dynamization, as low NUSS scores are associated with higher success rates. A study by Stolberg et al [ 71 ] demonstrated that NUSS scores are a relevant factor in the success of dynamization for bone non-unions. However, more clinical studies on the NUSS score and dynamization are needed to establish the effectiveness of this treatment approach for bone non-unions.…”