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High-energy extracorporeal shockwave therapy in humeral delayed and non-unions

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

Within the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions.

Materials and methods

A retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT.

Results

A total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002).

Conclusion

The findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.

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Data availability and material

Data will be made available upon reasonable request.

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Funding

There was no external source of funding for this study.

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Authors and Affiliations

  1. AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria

    Falko Dahm, Xaver Feichtinger, Sascha-Mario Vallant, Wolfgang Schaden, Christian Fialka & Rainer Mittermayr

  2. Women’s College Hospital, University of Toronto Orthopaedics Sports Medicine, Toronto, Canada

    Falko Dahm

  3. Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria

    Xaver Feichtinger, Wolfgang Schaden & Rainer Mittermayr

  4. Department for Orthopedics and Trauma Surgery, Krankenhaus Nord-Klinik Floridsdorf, Vienna, Austria

    Nicolas Haffner

  5. Austrian Cluster for Tissue Regeneration, Vienna, Austria

    Wolfgang Schaden & Rainer Mittermayr

  6. Medical Faculty, Sigmund Freud University, Vienna, Austria

    Christian Fialka

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  1. Falko Dahm
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  2. Xaver Feichtinger
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  4. Nicolas Haffner
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Correspondence to Falko Dahm.

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Conflict of interest

W.S. is holding ESWT related patents. F.D. has no conflict of interest. X.F. has no conflict of interest. S-M.V: has no conflict of interest. N.H. has no conflict of interest. C.F. has no conflict of interest. R.M. has no conflict of interest.

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Dahm, F., Feichtinger, X., Vallant, SM. et al. High-energy extracorporeal shockwave therapy in humeral delayed and non-unions. Eur J Trauma Emerg Surg 48, 3043–3049 (2022). https://doi.org/10.1007/s00068-021-01782-1

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  • DOI: https://doi.org/10.1007/s00068-021-01782-1

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