The role of shockwaves in the enhancement of bone repair - from basic principles to clinical application

Abstract

Extracorporeal shockwave therapy is a treatment modality, originally introduced into the clinic as lithotripsie, which has also been successfully used in the last two decades in the non-invasive treatment of delayed or non-healing fractures. Initially, the mechanism of action was attributed to microfractureinduced repair, but intensive basic research has now shown that the shockwave generates its effect in tissue via mechanotransduction. Numerous signal transduction pathways have already been demonstrated, which in their entirety trigger an endogenous regeneration process via cell proliferation, migration and differentiation. Clinically, these shockwave-conveyed biological signals support healing of acute, delayed and non-union fractures. The attainable outcome is comparable to surgery but avoiding an open approach with associated potential complications. These advantageous properties with a clearly positive cost-benefit ratio make shockwave therapy a first line treatment in delayed and non-union fractures.

The Effect of Space Travel on Bone Metabolism: Considerations on Today’s Major Challenges and Advances in Pharmacology

“…Besides studying the phenomenon from a molecular point of view, it would also be interesting to evaluate whether nonsurgical options currently in use on Earth to promote and facilitate bone regeneration in patients with healing deficiencies could be applied to space medicine for the treatment of mild fractures, which, in long-term spaceflights, could compromise astronaut performance. Among nonsurgical treatments, we find physical stimulation therapies, such as extracorporeal shockwave treatment (ESWT), low-intensity pulsed ultrasound (LIPUS) or low-level laser therapies (LLLT) [ 99 , 100 , 101 , 102 ]. The advantage of using nonsurgical countermeasures would lie in their non-invasive nature and easy application, which could allow the astronaut, in the event of minor fractures, rapid self-medication.…”

Extracorporeal shockwave therapy for the treatment of scaphoid delayed union in a tennis player: A case report

“…Among non-surgical options, ESWT has emerged as a reliable and effective non-invasive modality for patients with delayed union or non-union [1] . In ESWT, the term EFD is used to indicate the output.…”

“…Extracorporeal shock wave therapy (ESWT) is a non-invasive form of treatment that has been developed from extracorporeal shock wave lithotripsy in the field of urology [1] . In 1991, Valchanou et al reported its effectiveness in treating various delayed unions and non-unions for the first time [2] .…”

Implant failure after externally magnetic-controlled nail lengthening

“…A thicker implant, the use of growth factors (such as bone morphogenic proteins) or early extracorporeal shock wave therapy, and a more restrictive postoperative rehabilitation protocol might avoid implant failure. Mittermayr et al [18] reported in a recent study that extracorporeal shock wave therapy is a reliable, safe, and highly effective treatment for delayed union and nonunion. Moreover, Wehner et al [19] showed that for tibial shaft fractures the diameter of intramedullary nails should be as large as possible and the annular gap should be minimized to avoid a prolonged healing time.…”