gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

22. - 25.10.2019, Berlin

Importance of extracorporeal shockwave therapy as salvage procedure for femoral pseudarthrosis

Meeting Abstract

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  • presenting/speaker Frank Bätje - Privatpraxis Dr. Bätje, Hannover, Diakovere Friederikenstift Hannover, Hannover, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB40-234

doi: 10.3205/19dkou319, urn:nbn:de:0183-19dkou3194

Veröffentlicht: 22. Oktober 2019

© 2019 Bätje.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives: Is extracorporeal shockwave therapy (ESWT) an adequate alternative to surgery for pseudarthroses of extraarticular femoral fractures?

Methods: The outcome of all patients in working age treated with high-energetic (0.35-0.75 mJ/mm²) shockwaves due to fracture pseudarthrosis (2001-17) was analyzed retrospectively. The follow-up rate was 62.9% (n=154/245). Each case of this cohort (patient's age=17-67(Ø 48)ys., accident at work:private accident=106:48, additional risk factors:absence of risk factors=70:84, duration since fracture=1-24(Ø 8)ms.) were treated in one single shockwave center. Pseudarthrosis was defined as a fracture that does not heal without further interventions independent of the length of previous treatments - according to ESTROT. Bone healing was defined as sufficient bony fusion according to radiological criteria, loading capacity after implant removal and/or clear clinical improvement. Patients were treated with electromagnetic devices (most of all STORZ Modulith® SLK.)

Results and conclusion: An overall healing rate of 52.6% (81/154) was determined: 75.0% (18/24) at femoral neck, 51.4% (18/35) at trochanteric region, 49.8% (42/85) at femoral shaft and 30.0% (3/10) at supracondylar femur (Table 1 [Tab. 1]).

When comparing healed with unhealed cases there were no clear relationships between pseudarthrosis age, patient's age, or the number of ESWT sessions, resp. the total number of shock waves - with the exception of femur shaft non-unions with a significantly higher rate of osseous (e.g. open and/or compound fractures, osseous infections) or general (e.g. metabolic or cardiovascular disorders, or polytrauma) risk factors in unhealed cases (74.4% vs. 40.5%). The poor result in supracondylar femoral pseudarthroses was due to longer pseudarthrosis stages (∅ 12 ms.) and the existence of an above-average number of risk factors (100%) in these 10 cases. The good result in femoral neck pseudarthroases is particularly encouraging in view of the inevitable hip replacement in those cases. Different results at different localizations can also be found at other long bones. For more than 15 years, shock wave therapy experts have propagated a bone healing rate of 70-82% taking into account all long bone non-unions. The results of this retrospective study of a very heterogeneous cohort do not meet these ambitious expectations. But the overall healing rate among the above mentioned patients could be 65.5% for cases without, resp. 37.1% for cases with risk factors. Our longlasting experience as a „service provider“ for traumatologists in whole Germany has shown that ESWT-induced bone healing rates of almost 50% fully meet their special expectations. In summary, ESWT deserves a higher ranking among the options for treating pseudarthrosis of the femur.