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



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.


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).


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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Fig. 1

Data availability and material

Data will be made available upon reasonable request.


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Corresponding author

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 (2021).

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  • Extracorporeal shockwave therapy
  • ESWT
  • Non-union
  • Delayed union
  • Humerus