Article
The role of shockwave therapy (ESWT) in conservatively treated adult carpal scaphoid fracture nonunions – an alternative to surgery in cases of delayed diagnosis after injury
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Authors
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Frank Bätje
- Privatpraxis Dr. Bätje, Speaker`s Corner, Hannover, Germany
| Published: | October 6, 2022 |
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Outline
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Objectives: Fresh scaphoid fractures escape primary radiological diagnostics in approximately 10 to 15%. At this time, they often impress as delayed fracture healing or non-union without having been diagnosed in the acute stage. At the time of first diagnosis, surgical therapies are more complex compared with fresh fractures.
Is ESWT an adequate treatment alternative to non-union resection, bone grafting and osteosynthesis?
Method: Between 2008 and 2020, long-term results were determined among all cases (n=41) of delayed diagnosed scaphoid fractures that received shock wave therapy instead of primary surgery. Criteria of fracture healing were radiological findings and/or lack of subsequent surgical interventions and/or lack of specific complaints.
The STORZ Duolith® SD1 device with focused high-energy (energy flux density 0.35–0.55 mJ/mm²) shockwaves, usually without anesthesia, was used here in an outpatient setting. The results were checked at the earliest eight months after the end of therapy.
Results and Conclusion: 30 out of 36 (83%) cases that could be assessed sufficiently had healed: 89% within 6 months, 79% between 7 and 12 months, and 67% when diagnosed after one year and later.
All patients examined were male and 86% had private accidents. Only 1 patient (3%) had a more serious underlying internal disease. The main difference between cured and unhealed cases was fracture age at diagnosis: an average of 7 vs. 11 months. Other influencing factors (average age, number of shock wave therapies, total number) were irrelevant.
Treatment outcomes with ESWT vs. surgery were convincingly good and similar to those with primary surgical therapy. More serious side effects and complications didn't occur. Statements about the risk of premature radiocarpal osteoarthritis cannot be derived.
ESWT has been an established therapy for fracture healing disorders for 25 years. Their mode of action is based on microbiological effects on mesenchymal stem cells (mechanotransduction).
To our opinion, ESWT should be considered the 1st choice therapy for older, initially misdiagnosed scaphoid fractures.
