Can Focal Extracorporeal Shock Wave Therapy Promote Bone Consolidation and Improve Pain and Functionality? – A Case Series
Rafaela Evangelista1*, Marta Lages2, Tiago Félix1, Maria Vaz2, Bruno Lopes1, Ana Moreira1, Andreia Silva1, Pedro Almeida1, Pedro Coelho1, Luís Oliveira3, Tomás Silva4, Vera Ermida1, Jorge Caldas1
1 Department of Physical Medicine and Rehabilitation, Unidade Local de Saúde Viseu Dão-Lafões, Portugal.
2 Department of Orthopedics and Traumatology, Unidade Local de Saúde Viseu Dão-Lafões, Portugal.
3 Centro de Reabilitação do Norte, Portugal.
4 Department of Physical Medicine and Rehabilitation, Unidade Local de Saúde Santa Maria, Portugal.
*Corresponding Author: Rafaela Evangelista, 8877@ulsvdl.min-saude.pt, ORCID: 0000-0002-0951-9963
https://doi.org/10.58624/SVOAOR.2025.05.002
Received: December 17, 2024
Published: January 15, 2025
Citation: Evangelista R, Lages M, Félix T, Vaz M, Lopes B, Moreir A, Silva A, Almeida P, Coelho P, Oliveira L, Silva T, Ermida V, Caldas J. Can Focal Extracorporeal Shock Wave Therapy Promote Bone Consolidation and Improve Pain and Functionality? – A Case Series. SVOA Orthopaedics 2025, 5:1, 07-18. doi: 10.58624/SVOAOR.2025.05.002
Abstract
Background: Nonunion bone fractures cause chronic pain and disability, posing a significant burden on healthcare systems. Extracorporeal Shockwave Therapy (ESWT) has emerged as a promising non-invasive treatment, with studies showing bone healing success rates between 50% and 100%.
Methods: This study aims to evaluate the efficacy of focal ESWT (fESWT) in improving bone consolidation, pain, and functionality in patients with nonunion bone fractures, and to identify potential predictive factors of the treatment success rate. Inclusion criteria included nonunion bone fractures persisting over 9 months, pain and/or functional limitation, and skeletal maturity. Exclusion criteria included bone tumors, infected nonunions, instability of fixation devices, fracture gap size larger than 5mm, blood coagulation disorders, and pregnancy. Ultrasound was used to assess fracture depth, select the appropriate stand-off, and define the treatment area. The protocol involved three sessions of fESWT at one-week intervals. Patients underwent clinical and radiological evaluations at 3-, 6-, and 9-months following treatment.
Results: The study included 7 patients (5 males and 2 females, mean age 56.14 ± 18.68 years). Treatment was successful in 4 patients (57.1%) at 9 months post-treatment. NRS mean scores decreased significantly at 9 months, at rest and during movement, with overall reductions of 1.43 and 4.14 points, respectively. At 9 months, the qDASH mean score improved by 18.15 points, and the LEFS mean score increased by 22.20 points. Even in persistent nonunions after treatment, the NRS mean score at rest decreased by 1.67 points and during movement by 3.33 points. Additionally, functional outcomes improved, with the qDASH score increasing by 18.15 points and the LEFS score by 32.00 points. No adverse effects were observed. Patient satisfaction with the fESWT was "very good" in 42.9% of cases, "satisfactory" in 42.9%, and "good" in 14.3%.
Conclusions: fESWT is a safe and effective treatment for fracture nonunions in selected patients, including atrophic cases, with significant pain and functional improvement, even in persistent nonunions. Standardizing procedures is essential. Choosing fESWT may reduce healthcare costs by avoiding more invasive treatments.
Keywords: Nonunion, Extracorporeal Shock Wave Therapy, Bone Consolidation, Pain, Functionality