Clinical Study on the Treatment of Long Bone Fracture Non-union with Extracorporeal Shock Wave Therapy Combined with Platelet-rich Plasma

Original Article | Vol 3 | Issue 2 | July-December 2023 | page: 67-72 | RongDa Xu, JiaHui Li, ZhenCun Cai, Zhi Li, ZhiHao Liang, YuanLong Li, Lin Shen, HongLiang Tu, HongYu Zhou, Han Sun, Pei Li


Author: RongDa Xu [1], JiaHui Li [1], ZhenCun Cai [1], Zhi Li [2], ZhiHao Liang [2], YuanLong Li [3], Lin Shen [4], HongLiang Tu [5], HongYu Zhou [6], Han Sun [7], Pei Li [1]

[1] Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,
[2] Department of Orthopedics Surgery, Centro Hospitalar Conde de São Januário, Rua do Almirante Costa Cabral, Macau, China,
[3] Department of Orthopedics Surgery, Guangdong General Hospital, Yuexiu District, Guangzhou, China,
[4] Department of Hand Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China,
[5] Department of Orthopedics Surgery, 242 Hospital Affiliated to Shenyang Medical College, Huanggu District, China,
[6] Department of Orthopedics Surgery, Shenyang Orthopedic Hospital, Dadong District, Shenyang, China,
[7] Department of Orthopedics Surgery, Liaoyang County Central Hospital, Liaoyang, China.

Address of Correspondence

Dr. Pei Li,
Department of Orthopedics Surgery, Central Hospital Affiliated to Shenyang Medical College, Shenyang, China.


Objective: The objective of the study was to evaluate of the therapeutic efficacy of extracorporeal shock wave therapy (ESWT) combined with platelet-rich plasma (PRP) injection in patients with long bone fracture non-union.
Material and Methods: A total of 36 patients identified with long bone fracture non-union treated from September 2020 to September 2023 were enrolled into this study. Employing a random number table method, they were randomly divided into three groups, with 12 cases in each group. Based on the treatment modality, the groups were categorized as the ESWT group, PRP group, and combination ESWT + PRP group. Routine radiographs and musculoskeletal ultrasound were obtained before treatment and at 3-, 6-, and 9-month post-treatment intervals to observe for bone callus formation and assess fracture line imaging scores with the aim to evaluate the treatment efficacy of each group.
Results: With the extension of treatment time, the bone callus and fracture line imaging scores of the three groups gradually increased (P < 0.05). At 3-, 6-, and 9-month post-treatment, the scores of the ESWT combined with the PRP group were significantly better than those of the singular ESWT group and PRP group, and the differences were statistically significant (P < 0.05).
Conclusion: Therapy with singular ESWT, singular PRP, and combination ESWT + PRP has demonstrated effective improvement in fracture healing for patients with long bone fracture non-union. The synergistic effects of combination therapy were more significant, surpassing the efficacy of singular ESWT or PRP applications. The combined use of ESWT and PRP represents a safe and promising alternative treatment for long-bone fracture non-union, making it a compelling choice in the context of fracture healing.
Keywords: Extracorporeal shock wave therapy, Platelet-rich plasma, Non-union of fracture.


1. Wu W, Tang P. The research progress on treatment methods for nonunion of bones. China Contin Med Educ 2017;9:126-9.
2. Panteli M, Vun JS, Pountos I, J Howard A, Jones E, Giannoudis PV. Biological and molecular profile of fracture non-union tissue: A systematic review and an update on current insights. J Cell Mol Med 2022;26:601-23.
3. Smolinska V, Csobonyeiova M, Zamborsky R, Danisovic L. Stem cells and their derivatives: An implication for the regeneration of nonunion fractures. Cell Transplant 2023;32:9636897231183530.
4. Wang X, Cui Y, Zhang L. Advances in treatment strategies and mechanisms for promoting fracture healing research. Chin Bull Life Sci 2021;33:121-30.
5. Schlickewei CW, Kleinertz H, Thiesen DM, Mader K, Priemel M, Frosch KH, et al. Current and future concepts for the treatment of impaired fracture healing. Int J Mol Sci 2019;20:5805.
6. Lai Y, Han J. The role and advances of extracellular vesicles in the mechanisms of bone nonunion treatment. Chin J Tissue Eng Res 2020;24:4349-55.
7. Zheng H, Zhang W, Wang Y, He B,Shen Y,Fan L. Femoral neck system combined with platelet-rich plasma in the treatment of femoral neck fracture. Chin J Tissue Eng Res 2023;27:1390-5.
8. Lv F, Li Z, Jing Y, Sun L, Li Z, Duan H. The effects and underlying mechanism of extracorporeal shockwave therapy on fracture healing. Front Endocrinol 2023;14:1188297.
9. Wang H, Shi Y. Extracorporeal shock wave treatment for post-surgical fracture nonunion: Insight into its mechanism, efficacy, safety and prognostic factors (Review). Exp Ther Med 2023;26:332.
10. Liang H, Jia H, Zhu J, Hu F, Li H, Xiao J, et al. Guidelines for extracorporeal shock wave therapy for musculoskeletal disorders in China (2023 Edition). Chin J Front Med Sci 2023;15:1-20.
11. Willems A, van der Jagt OP, Meuffels DE. Extracorporeal shock wave treatment for delayed union and nonunion fractures: A systematic review. J Orthop Trauma 2019;33:97-103.
12. Trinchese GF, Cipollaro L, Calabrese E, Maffulli N. Platelet-rich plasma, mesenchymal stem cell, and non-metallic suture-based fixation technique in a patellar fracture nonunion: A technical note and systematic review. Clin Orthop Surg 2021;13:344-51.
13. Fang J, Wang X, Jiang W, Zhu Y, Hu Y, Zhao Y, et al. Platelet-rich plasma therapy in the treatment of diseases associated with orthopedic injuries. Tissue Eng Part B Rev 2020;26:571-85.
14. Yin N, Wang Y, Ding L, Yuan J, Du L, Zhu Z, et al. Platelet-rich plasma enhances the repair capacity of muscle-derived mesenchymal stem cells to large humeral bone defect in rabbits. Sci Rep 2020;10:6771.
15. Li S, Xing F, Luo R, Liu M. Clinical effectiveness of platelet-rich plasma for long-bone delayed union and nonunion: A systematic review and meta-analysis. Front Med (Lausanne) 2022;8:771252.
16. Seabaugh KA, Thoresen M, Giguère S. Extracorporeal shockwave therapy increases growth factor release from equine platelet-rich plasma in vitro. Front Vet Sci 2017;4:205.
17. Nicholson JA, Tsang ST, MacGillivray TJ, Perks F, Simpson AH. What is the role of ultrasound in fracture management?: Diagnosis and therapeutic potential for fractures, delayed unions, and fracture-related infection. Bone Joint Res 2019;8:304-12.
18. Sun L, Zhang N, Tu H, Li P. The application value of musculoskeletal ultrasound in long tubular bone fractures and nonunion shock wave therapy. Chin J Med Ultrasound 2019;16:827-31.


How to Cite this article: Xu R, Li J, Cai Z, Li Z, Liang Z, Li Y, Shen L, Tu H, Zhou H, Sun H, Li P | Clinical Study on the Treatment of Long Bone Fracture Non-union with Extracorporeal Shock Wave Therapy Combined with Platelet-rich Plasma. | Journal of Regenerative Science | Jul-Dec 2023; 3(2): 67-72.


[Full Text HTML] [Full Text PDF] 

0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *