Abstracts - ISMST - International Society for Medical Shockwave ...

Abstracts
shock waves were used for the treatment of bone pseudoarthrosis in humans. Here we report our experience in Verona
treating bone pseudoarthrosis by means of ESWT.
Methods: Between 1997 and 2009 a total of 674 bone pseudarthrosis were treated, with a minimum follow up of 6 months
Most consisted of long bone pseudarthrosis.
The electromagnetic coil lithotripter (Modulith SLK by Storz Medical AG) used included in-line radiographic targeting
and the Lithotrack system. The protocol usually consisted of one cycle of 3-4 sessions depending on the intrinsic
characteristics of pseudarthrosis
Typically no general or local anesthesia was required. All pseudarthrosis, if not surgically stabilized or well fixed, were
immobilized with a brace.
Results: Bony union was achieved in 78.6% of patients. Failures were experienced more often in atrophic pseudarthrosis.
Some bones (humerus and carpal scaphoid) proved to be less sensitive to shock waves than others.
No serious complications were observed.
Discussion: The success rate of ESWT is very high and is comparable to results obtained with surgical procedures. It is a
non-invasive method, and surgery can still be performed if Shockwave Therapy fails. Moreover the mass of data analyzed
furnishes information concerning more exact indications and new prognostic factors.
Conclusion: These considerations led to consider ESWT as a therapeutic method not only characterized by a high
success rate, but also that is well tolerated and accepted by patients because of its non-invasiveness and absence of
complications. Also considering its low cost compared to surgery, we can say that ESWT should be proposed as the first
approach to bone pseudarthrosis.
28. Quality Control of ESWT in the treatment of Non-Union fractures
Wolfgang Schaden(1), Andreas Fischer(2), Ender Karadas(2), Rainer Mittermayr(1)
Institution:
1 AUVA Trauma Centre Meidling, Vienna, Austria + shockwavetherapy-vienna.com
2 AUVA Trauma Centre Meidling, Vienna, Austria
Device and producing company: Ossatron, HMT, Orthowave 280, TRT and MTS
Introduction: Since December 1998 delayed and non-union fractures have been treated with ESWT on a regular basis in
the AUVA Trauma Centre Meidling. Up to December 2009 a total of 1611 patients were treated and 70 parameters were
documented for each patient. The data set includes demographic data, medical history, treatment parameters, side
effects, and follow-up treatment as well as 3 and 6-month results. Since 153 (9.5%) patients were lost to follow-up, data
for only 1458 patients is available.
Methods: Because the data were collected in a linked access database some important correlations can be made
immediately. The database will be demonstrated during the presentation and the audience will have the opportunity to ask
questions concerning age of the patients, age of the non-unions, treatment parameters, etc. in correlation to the outcome
(3 and 6-month results).
For example,
Question: “What was the healing rate in patients over 80 years of age that received ESWT for their non-unions?”
Answer: n = 50 (14 male/34 female); mean age: 83.8 (range: 80-93); 47 fractures / 3 osteotomies; metaphyseal = 27 /
diaphyseal = 23; healing rate after 3 months: 32 (64%); after 6 months: 42 (84%).
Results: The overall healing rate was 77% (1120). Only minor side effect, such as temporary superficial haematoma,
petechial bleedings and reddening of the skin, were observed. None of them had a clinical impact and disappeared after 3
to 5 days without treatment.
Discussion: The quality control facilitated by collecting these data enabled us to optimize treatment parameters. The
treatments were performed by a total of 25 trauma surgeons and there were no significant differences in the outcomes
between the physicians.
Conclusion: These results prove that ESWT for the treatment of delayed and non-healing fractures is not only efficient and
safe but has practically no learning curve and is easily reproducible.
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