gms | German Medical Science

Objectives: Femur neck fractures are significant due to high incidence and perioperative morbidity and mortality and belong to the most serious fractures of the elderly. Due to the demographic situation, the number of cases is increasing. In addition to dislocations and femoral head necrosis, delayed and non-unions represent the most common complications after osteosyntheses: according to different sources in up to 25%. Approximately 20% of patients with osteosyntheses, most likely younger patients, receive a total hip arthroplasty in the further course of their treatment.

The fracture healing rate was determined retrospectively after ESWT in the stage of disturbed fracture healing.

The value of this method is compared with re-osteosynthesis with and without correctional osteotomies.

Methods: A total of 24 consecutive cases of impaired bone healing after fractures of the femur neck (86% surgically, 14% conservatively treated) received focused high-energetic shockwaves of the fracture gap. Retrospectively it was determined how often sufficient bony healing or persistent pseaudarthroses could be diagnosed, whether surgical follow-up procedures had to be carried out, or femoral head necrosis had been diagnosed.

Gender relationship (male:female) was 16:8, patient's average age 47 ys. (20-65 ys.), average time after surgery or fracture 6,2 ms. (3-18 ms.)

All patients received two sessions (1-3) with 7150 (3200-12000) high-energetic shockwaves with an electromagnetic shockwave emitter (STORZ MODULITH® SLK) after radiographic guidance without anaethesia in a clinical but outpatient setting.

Results and Conclusion: In 22 of 24 cases, retrospective results were obtained (follow up rate 92%). 14 pseudarthroses were healed, 7 unhealed, (and 1 drop out) corresponding to a healing rate of 67%.

For delayed unions, it was 69%, compared with 62% after non-unions.

The mean age of the healed patients was 51 ys, compared with 42 ys. of the unhealed persons.

A coincidence with general and/or fracture related accompanying risks was 7% of all cured patients, and 57% of unhealed cases.

After accidents at work the succes rate was 78%, after private accidents only 58%.

The non-invasive extracorporeal shockwave therapy (ESWT) is an alternative to re-osteosynthesis or total hip arthroplasty in cases of bony healing disorders after joint-preserving treatment of femoral neck fractures. Advantages are given particularly for patients without accompanying medical risks and in the absence of existential circumstances during rehabilitation.

The microbiological effects (mechanotransduction of mesenchymal stem cells) of focused shock waves with respect to osteoinductive mechanisms have been sufficiently investigated. There are guidelines and defined requirements for performing doctors and their therapy equipment. Overall healing rates of 75-80% in all bony indications are now more reality than vision. Therefore ESWT should be given greater attention as a competitive therapy method for bone healing problems.