Posts

Focused Shock Waves in Delayed Union and No-union after Intramedullary Nailing in Lower Limbs

/0 Comments/in /by

Case Report | Vol 4 | Issue 1 |  January-June 2024 | page: 06-08 | Josep Pous

DOI: https://doi.org/10.13107/jrs.2024.v04.i01.121

 

Author: Josep Pous [1]

[1] Orthopaedic Surgeon and Medical Director of CEMATEC, Barcelona, España.

Address of Correspondence
Dr. Josep Pous,
Orthopaedic Surgeon and Medical Director of CEMATEC, Barcelona, España.
E-mail: jpous@cematec.org

Abstract

Shock waves have changed medical therapy substantially. Accounting for the epidemiology of the treated diseases, this therapeutic tool may equal or even surpass the impact of extracorporeal shock wave lithotripsy. Lower limb fractures after intramedullary nailing generally heal without problems when there are good local conditions and no associated pathologies, but sometimes if the biomechanical or biological variables are not ideal, they can lead to a delay in healing or develop a non-union. Extracorporeal shock waves therapy is a treatment option in delayed union and no-union after intramedullary nailing in lower limbs cases in which there is mechanical stability of the fracture focus, as they can allow healing without the need for new surgeries.
Keywords: Extracorporeal shockwave therapy, Shock waves, Non-union, Delayed union

References:

1. Jensen SS, Jensen NM, Gundtoft PH, Kold S, Zura R, Viberg B. Risk factors for nonunion following surgically managed, traumatic, diaphyseal fractures: A systematic review and meta-analysis. EFORT Open Rev 2022;7:516-25.
2. Zura R, Mehta S, Della Rocca GJ, Steen RG. Biological risk factors for nonunion of bone fracture. JBJS Rev 2016;4:e5.
3. Sadat-Ali M, Al-Omar HK, AlTabash KW, AlOmran AK, AlDakheel DA, AlSayed HN. Genetic influence of fracture nonunion (FNU): A systematic review. Pharmgenomics Pers Med 2023;16:569-75.
4. Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The role of extracorporeal shockwave treatment in musculoskeletal disorders. J Bone Joint Surg Am 2018;100:251-63.
5. Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, et al. Epidemiology of fracture nonunion in 18 human bones. JAMA Surg 2016;151:e162775.
6. Tian R, Zheng F, Zhao W, Zhang Y, Yuan J, Zhang B, et al. Prevalence and influencing factors of nonunion in patients with tibial fracture: Systematic review and meta-analysis. J Orthop Surg Res 2020;15:377.
7. Rompe JD, Rosendahl T, Schöllner C, Theis C. High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop Relat Res 2001;387:102-11.
8. Tamma R, Dell’Endice S, Notarnicola A, Moretti L, Patella S, Patella V, et al. Extracorporeal shock waves stimulate osteoblast activities. Ultrasound Med Biol 2009;35:2093-100.
9. Hofmann A, Ritz U, Rompe JD, Tresch A, Rommens PM. The effect of shock wave therapy on gene expression in human osteoblasts isolated from hypertrophic fracture non-unions. Shock Waves 2015;25:1:91-102.
10. Suhr F, Delhasse Y, Bungartz G, Schmidt A, Pfannkuche K, Bloch W. Cell biological effects of mechanical stimulations generated by focused extracorporeal shock wave applications on cultured human bone marrow stromal cells. Stem Cell Res 2013;11:951-64.
11. Wang CJ, Huang KE, Sun YC, Yang YJ, Ko JY, Weng LH, et al. VEGF modulates angiogenesis and osteogenesis in shockwave-promoted fracture healing in rabbits. J Surg Res 2011;171:114-9.
12. Li B, Wang R, Huang X, Ou Y, Jia Z, Lin S, et al. Extracorporeal shock wave therapy promotes osteogenic differentiation in a rabbit osteoporosis model. Front Endocrinol (Lausanne) 2021;12:627718.
13. Haupt G. Use of extracorporeal shock waves in the treatment of pseudarthrosis, tendinopathy and other orthopedic diseases. J Urol 1997;158:4-11.
14. Alkhawashki HM. Shock wave therapy of fracture nonunion. Injury 2015;46:2248-52.
15. 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.
16. Sansone V, Ravier D, Pascale V, Applefield R, Del Fabbro M, Martinelli N. Extracorporeal shockwave therapy in the treatment of nonunion in long bones: A systematic review and meta-analysis. J Clin Med 2022;11:1977.
17. Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res 2001;387:95-101.
18. Cacchio A, Giordano L, Colafarina O, Rompe JD, Tavernese E, Ioppolo F, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am 2009;91:2589-97. Erratum in: J Bone Joint Surg Am 2010;92:1241.
19. Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am 2010;92:846-54.
20. Notarnicola A, Moretti L, Tafuri S, Gigliotti S, Russo S, Musci L, et al. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid. Ultrasound Med Biol 2010;36:1306-13.
21. Schaden W, Mittermayr R, Haffner N, Smolen D, Gerdesmeyer L, Wang CJ. Extracorporeal shockwave therapy (ESWT)–first choice treatment of fracture non-unions? Int J Surg 2015;24:179-83.
22. Haffner N, Antonic V, Smolen D, Slezak P, Schaden W, Mittermayr R, et al. Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury 2016;47:1506-13.
23. Sandoval C, Valenzuela A, Rojas C, Brañes M, Guiloff L. Extracorporeal shockwave therapy for atrophic and oligotrophic nonunion of tibia and femur in high energy trauma patients. Case series. Int J Surg 2017;9:36-40.

How to Cite this article: Pous J. Focused Shock Waves in Delayed Union and No-union after Intramedullary Nailing in Lower Limbs. Journal of Regenerative Science 2024;January-June;4(1):06-08

[Article Text HTML]       [Full Text PDF] 

20 Years of Treatment of Bone Non-Unions and Delayed Unions with Shock Waves

/0 Comments/in /by

??? | Vol 4 | Issue 1 |  January-June 2024 | page: 27-30| Paulo F Kertzman

DOI: https://doi.org/10.13107/jrs.2024.v04.i01.131

Author: Paulo F Kertzman [1]

[1] Departamento de Ortopedia, Santa Casa de São Paulo, São Paulo, SP, Brazil.

Address of Correspondence
Dr. Paulo F Kertzman
Departamento de Ortopedia, Santa Casa de São Paulo, São Paulo, SP, Brazil.
E-mail: paulofkertzman@uol.com.br

Abstract

The treatment of bone non-unions continues to be complex and prolonged in many cases. The advent of the use of mechanical waves has made it possible, through the phenomenon of mechanotransduction, to have a non-invasive tool with a low rate of complications.
This study analyzes the experience of the last 20 years with the use of shock waves.

Keywords: Non-union, shock waves, Delayed union, Mechanotransduction

References:

1- Bell A, Templeman D, Weinlein JC. Nonunion of the femur and Tibia: An update. Orthop Clin North Am 2016;47:365-75.
2- Ekegren CL, Edwards ER, de Steiger R, Gabbe BJ. Incidence, Costs and Predictors of Non-Union, Delayed Union and Mal-Union Following Long Bone Fracture. Int J Environ Res Public Health. 2018 Dec 13;15(12):2845. doi: 10.3390/ijerph15122845. PMID: 30551632; PMCID: PMC6313538.
3- Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal long bone nonunions – Types, aetiology, economics, and treatment recommendations. Int Orthop 2017;42:247-58.
4- Schaden W, Mittermayr R, Haffner N, Smolen D, Gerdesmeyer L, Wang CJ. Extracorporeal shockwave therapy (ESWT)–First choice treatment of fracture non-unions? Int J Surg 2015;24:179-83.
5- Wang CJ, Chen HS, Chen CE, Yang KD. Treatment of nonunions of long bone fractures with shock waves. Clin Orthop Relat Res 2001;387:95-101.
6- Haupt G, Haupt A, Gerety B, Chvapil M. Enhancement of fracture healing with extracorporeal shock waves. J Urol 1990;158:4.
7- Valchanou VD, Michailov P. High energy shock waves in the treatment of delayed and nonunion of fractures. Int Orthop. 1991;15(3):181-4. doi: 10.1007/BF00192289. PMID: 1743828.
8- Main G, Haupt A, Ekkernkamp A, Gerety B, Chvapil M. Influence of shock waves on fracture healing. Urology 1992;39:529-32.
9- Kertzman P, Lenza M, Pedrinelli A, Ejnisman B. Shockwave treatment for musculoskeletal diseases and bone consolidation: Qualitative analysis of the literature. Rev Bras Ortop 2015;50:3-8.
10- Cheng JH, Wang CJ. Biological mechanism of shockwave in bone. Int J Surg. 2015 Dec;24(Pt B):143-6. doi: 10.1016/j.ijsu.2015.06.059. Epub 2015 Jun 25. PMID: 26118613.
11- Schnurrer-Luke-Vrbanić T, Avancini-Dobrović V, Sosa I, Cvijanovic O, Bobinac D. Effect of radial shock wave therapy on long bone fracture repair. J Biol Regul Homeost Agents. 2018 Jul-Aug;32(4):875-879. PMID: 30043570.
12- d’Agostino MC, Craig K, Tibalt E, Respizzi S. Shock wave as biological therapeutic tool: From mechanical stimulation to recovery and healing, through mechanotransduction. Int J Surg. 2015 Dec;24(Pt B):147-53. doi: 10.1016/j.ijsu.2015.11.030. Epub 2015 Nov 28. PMID: 26612525.
13- Wang CJ, Wang FS, Yang KD. Biological effects of extracorporeal shockwave in bone healing: a study in rabbits. Arch Orthop Trauma Surg. 2008 Aug;128(8):879-84. doi: 10.1007/s00402-008-0663-1. Epub 2008 Jun 17. PMID: 18560855.
14- Ha CH, Kim S, Chung J, An SH, Kwon K. Extracorporeal shock wave stimulates expression of the angiogenic genes via mechanosensory complex in endothelial cells: mimetic effect of fluid shear stress in endothelial cells. Int J Cardiol. 2013 Oct 9;168(4):4168-77. doi: 10.1016/j.ijcard.2013.07.112. Epub 2013 Aug 1. PMID: 23915523.
15- Xu JK, Chen HJ, Li XD, Huang ZL, Xu H, Yang HL, Hu J. Optimal intensity shock wave promotes the adhesion and migration of rat osteoblasts via integrin β1-mediated expression of phosphorylated focal adhesion kinase. J Biol Chem. 2012 Jul 27;287(31):26200-12. doi: 10.1074/jbc.M112.349811. Epub 2012 May 31. PMID: 22654119; PMCID: PMC3406705.
16- Sun D, Junger WG, Yuan C, Zhang W, Bao Y, Qin D, Wang C, Tan L, Qi B, Zhu D, Zhang X, Yu T. Shockwaves induce osteogenic differentiation of human mesenchymal stem cells through ATP release and activation of P2X7 receptors. Stem Cells. 2013 Jun;31(6):1170-80. doi: 10.1002/stem.1356. PMID: 23404811; PMCID: PMC4243484.
17- Wang FS, Wang CJ, Chen YJ, Chang PR, Huang YT, Sun YC, et al. Ras induction of superoxide activates ERK-dependent angiogenic transcription factor HIF-1alpha and VEGF-A expression in shock wave-stimulated osteoblasts. J Biol Chem 2004;279:10331-7.
18- Kusnierczak D, Brocai DR, Vettel U, Loew M. Der Einfluss der extrakorporalen Stosswellenapplikation (ESWA) auf das biologische Verhalten von Knochenzellen in vitro [Effect of extracorporeal shockwave administration on biological behavior of bone cells in vitro]. Z Orthop Ihre Grenzgeb. 2000 Jan-Feb;138(1):29-33. German. doi: 10.1055/s-2000-10109. PMID: 10730360.
19- Császár NB, Angstman NB, Milz S, Sprecher CM, Kobel P, Farhat M, Furia JP, Schmitz C. Radial Shock Wave Devices Generate Cavitation. PLoS One. 2015 Oct 28;10(10):e0140541. doi: 10.1371/journal.pone.0140541. PMID: 26509573; PMCID: PMC4625004.
20- Xu ZH, Jiang Q, Chen DY, Xiong J, Shi DQ, Yuan T, Zhu XL. Extracorporeal shock wave treatment in nonunions of long bone fractures. Int Orthop. 2009 Jun;33(3):789-93. doi: 10.1007/s00264-008-0553-8. Epub 2008 Apr 25. PMID: 18437381; PMCID: PMC2903117.
21- Bara T, Synder M. Nine-years experience with the use of shock waves for treatment of bone union disturbances. Ortop Traumatol Rehabil. 2007 May-Jun;9(3):254-8. English, Polish. PMID: 17721422.
22- Rompe JD, Rosendahl T, Schöllner C, Theis C. High-energy extracorporeal shock wave treatment of nonunions. Clin Orthop Relat Res. 2001 Jun;(387):102-11. doi: 10.1097/00003086-200106000-00014. PMID: 11400870.
23- Schaden W, Fischer A, Sailler A. Extracorporeal shock wave therapy of nonunion or delayed osseous union. Clin Orthop Relat Res 2001;387:90-4.
24- Vulpiani MC, Vetrano M, Conforti F, Minutolo L, Trischitta D, Furia JP, Ferretti A. Effects of extracorporeal shock wave therapy on fracture nonunions. Am J Orthop (Belle Mead NJ). 2012 Sep;41(9):E122-7. PMID: 23365814.
25- Kuo SJ, Su IC, Wang CJ, Ko JY. Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures. Int J Surg. 2015 Dec;24(Pt B):131-4. doi: 10.1016/j.ijsu.2015.06.075. Epub 2015 Jul 9. PMID: 26166737.
26- Moya D, Ramón S, Schaden W, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. J Bone Joint Surg Am. 2018 Feb 7;100(3):251-263. doi: 10.2106/JBJS.17.00661. PMID: 29406349.
27- Kertzman P, Császár NB, Furia JP, Schmitz C. Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: A retrospective case series. J Orthop Surg Res 2017;12:164.
28- Cacchio A, Giordano L, Colafarina O, Rompe JD, Tavernese E, Ioppolo F, et al. Extracorporeal shock-wave therapy compared with surgery for hypertrophic long-bone nonunions. J Bone Joint Surg Am 2009;91:2589-97.
29- Furia JP, Juliano PJ, Wade AM, Schaden W, Mittermayr R. Shock wave therapy compared with intramedullary screw fixation for nonunion of proximal fifth metatarsal metaphyseal-diaphyseal fractures. J Bone Joint Surg Am 2010;92:846-54.
30- Quadlbauer S, Pezzei C, Beer T, Jurkowitsch J, Keuchel T, Schlintner C, Schaden W, Hausner T, Leixnering M. Treatment of scaphoid waist nonunion by one, two headless compression screws or plate with or without additional extracorporeal shockwave therapy. Arch Orthop Trauma Surg. 2019 Feb;139(2):281-293. doi: 10.1007/s00402-018-3087-6. Epub 2018 Dec 6. PMID: 30523445.
31- Notarnicola A, Moretti L, Tafuri S, Gigliotti S, Russo S, Musci L, Moretti B. Extracorporeal shockwaves versus surgery in the treatment of pseudoarthrosis of the carpal scaphoid. Ultrasound Med Biol. 2010 Aug;36(8):1306-13. doi: 10.1016/j.ultrasmedbio.2010.05.004. PMID: 20691920.
32- Schmitz C, Császár NB, Milz S, Schieker M, Maffulli N, Rompe JD, Furia JP. Efficacy and safety of extracorporeal shock wave therapy for orthopedic conditions: a systematic review on studies listed in the PEDro database. Br Med Bull. 2015;116(1):115-38. doi: 10.1093/bmb/ldv047. Epub 2015 Nov 18. PMID: 26585999; PMCID: PMC4674007.
33- Birnbaum K, Wirtz DC, Siebert CH, Heller KD. Use of extracorporeal shock-wave therapy (ESWT) in the treatment of non-unions. A review of the literature. Arch Orthop Trauma Surg. 2002 Jul;122(6):324-30. doi: 10.1007/s00402-001-0365-4. Epub 2002 Mar 12. PMID: 12136295.
34- Petrisor B, Lisson S, Sprague S. Extracorporeal shockwave therapy: A systematic review of its use in fracture management. Indian J Orthop. 2009 Apr;43(2):161-7. doi: 10.4103/0019-5413.50851. PMID: 19838365; PMCID: PMC2762266.
35- 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 Feb;33(2):97-103. doi: 10.1097/BOT.0000000000001361. PMID: 30570614.
36- Schnurrer-Luke-Vrbanic T, Avancini-Dobrovic V, Sosa I, Cvijanovic O, Bobinac D. VEGF-A expression in soft tissues repaired by shockwave therapy: differences between modalities. J Biol Regul Homeost Agents. 2018 May-Jun;32(3):583-588. PMID: 29921384.
37- Gollwitzer H, Gloeck T, Roessner M, Langer R, Horn C, Gerdesmeyer L, et al. Radial extracorporeal shock wave therapy (rESWT) induces new bone formation in vivo: Results of an animal study in rabbits. Ultrasound Med Biol 2013;39:126-33.
38- Diaz-Rodriguez L, Garcia-Marinez O, Arroyo-Morales M, Ramos-Torrecillas J, De Luna-Bertos E, Ruiz C. Effect of radial extracorporeal shock wave therapy on proliferation, cell viability and phagocytosis of human osteoblasts (MG63). Adv Sci Lett 2012;17:325-9.
39- Silk ZM, Alhuwaila RS, Calder JD. Low-energy extracorporeal shock wave therapy to treat lesser metatarsal fracture nonunion: Case report. Foot Ankle Int 2012;33:1128-32.
40- Kertzman PF, Fucs PM. Does radial shock wave therapy works in pseudarthrosis? Prospective analysis of forty four patients. Int Orthop 2021;45:43-9.

 

How to Cite this article: Kertzman PF. 20 Years of Treatment of Non-Unions and Delayed Unions with Shock Waves. Journal of Regenerative Science 2024;January-June;4(1):27-30.

 

[Article Text HTML]       [Full Text PDF]