Extracorporeal shock wave therapy for bony non-union. Evidence-based therapy - Review of the literature and personal results

Extracorporeal shock wave therapy (ESWT) is applied increasingly in the treatment of bone and soft tissue pathologies. Animal studies have yielded a broad scientific basis supporting the efficacy of ESWT in bone stimulation and also demonstrated its osteogenic potency. Discussion of molecular mechanisms of action has concentrated mainly on cell membrane hyperpolarization and radical production, followed by stimulation of osteoprogenitor cells and expression of growth factors. Clinical studies also indicate that ESWT is effective in the treatment of non-union and healing rates of 41-89% have been observed, but only on the basis of level IV evidence derived from uncontrolled studies. Among 601 patients prospectively treated for non-union, we achieved a consolidation rate of 83%. However, real evidence of its efficacy is still lacking. Until a randomized controlled study provides this ESWT must be recommended on the basis of the best available evidence - not least because of its lowlevel risks and side effects and positive costbene fit ratio. More scientific data is available on ESWT than on most other conservative and operative treatment options for patients with bony non-union.