History of Shock Wave Therapy: Pseudarthroses

Disorders called pseudarthroses can occur in rare cases when bone fractures heal. Certain bones are more frequently affected than others, such as the long bones (lower leg, upper leg, upper arm and ulna with radius) or the scaphoid bone. Conventional treatment occurs via surgical intervention. Today, however, shock wave therapy is being used more and more frequently as an alternative, to great success; a success story which began in the early 1990's.

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ESWT in a femoral non-union fracture

After its introduction in 1980, extracorporeal shock wave lithotripsy (SWL) permanently established itself by the early 1990's and revolutionized urological stone therapy. As a result of the extraordinarily positive successes in urological stone therapy and in the treatment of non-urological intracorporeal concretions, using shock waves in other fields was obvious. This often occurred according to the principle of »trial and error«. One of these new fields was that of pseudarthroses.

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ESWT in a radius non-union fracture

The Start of a Success Story
The osteogenetic potential of shock waves was already discovered in 1990 by Haupt et al. in a rat fracture model with an experimental lithotripter. Based on the radiological, histological and biochemical results, a stimulation of healing of the fracture with shock waves was demonstrated. In parallel to this, Valchanov et al. (Sofia, Bulgaria) reported on the first shock wave treatments of pseudarthroses in 1991. In 1992, at the Ruhr University of Bochum, Germany, trials performed on rats indicated that ESWT is a very effective treatment method in the case of pseudarthroses. In the same year, R. Schleberger and T. Senge (Bochum) also reported on the treatment of four patients: Callus formation occurred in three patients within six weeks as a result of an ESWT treatment.

As a result, additional patients were treated at the Ruhr University of Bochum. In a retrospective investigation, G. Haupt and P. Katzmeier (Bochum) evaluated the treatment results of 30 patients with pseudarthroses. A consolidation of the bone, recognizable in X-ray images, was achieved after a one-time treatment in the case of 22 patients. Since that time, numerous additional studies have proven the effectiveness of extracorporeal shockwave therapy in the treatment of pseudarthroses.

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Humeral fracture before ESWT (left), Humeral fracture after ESWT (middle), Humeral fracture after ESWT and implant removal (right)
– Dr. Frank Bätje, Hannover GER

Worldwide Success
Today, extracorporeal shockwave therapy is successfully used around the world in the treatment of non-healing bone fractures. Leading scientists and researchers recommend the method as a therapy option for treating non-healing fractures of the long bones. Current studies published in respected scientific journals (Cacchio et al. 2009; Furia et al. 2010) show that shock wave therapy is practically free of complication and low-stress for the patient.

At a Glance

  • 1992: First demonstrations of the effectiveness of ESWT for pseudarthroses on animals and people.
  • Today: ESWT is successfully used around the world in the treatment of non-healing bone fractures.
  • Effectiveness documented in numerous studies
  • Practically free of complication and low-stress for the patient


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