Extracorporeal Shock Wave Treatment for Delayed Union and Nonunion Fractures: A Systematic Review
2019
markdownabstractObjectives: Nonunions after bone fractures are usually treated
surgically with risk of infections and failure of osteosynthesis. A
noninvasive alternative is extracorporeal shock wave treatment
(ESWT), which potentially stimulates bone regeneration. Therefore
this review investigates whether ESWT is an effective and safe
treatment for delayed unions and nonunions.
Data Sources: Embase.com, MEDLINE ovid, Cochrane, Web of
Science, PubMed publisher, and Google Scholar were systematically
searched.
Study Selection: Inclusion criteria included studies with patients
with delayed union or nonunion treated with ESWT; inclusion of
$10 patients; and follow-up period $6 weeks.
Data Extraction: Assessment for risk of bias was conducted by 2
authors using the Cochrane tool. Union rates and adverse events
were extracted from the studies.
Data Synthesis: Two RCTs and 28 nonrandomized studies were
included. One RCT was assessed at medium risk of bias and reported
similar union rates between ESWT-treated patients (71%) and
surgery-treated patients (74%). The remaining 29 studies were at
high risk of bias due to poor description of randomization (n = 1),
nonrandomized allocation to control groups (n = 2), or absence of
control groups (n = 26). The average union rate after ESWT in
delayed unions was 86%, in nonunions 73%, and in nonunions after
surgery 81%. Only minor adverse events were reported after ESWT.
Conclusions: ESWT seems to be effective for the treatment of
delayed unions and nonunions. However, the quality of most studies
is poor. Therefore, we strongly encourage conducting well-designed
RCTs to prove the effectiveness of ESWT and potentially improve
the treatment of nonunions because ESWT might be as effective as
surgery but safer.
Level of Evidence: Therapeutic Level III. See Instructions for
Authors for a complete description of levels of evidence
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