Treatment of nonunion of bone fractures by shock wave therapy
What is nonunion of bone fractures?
Treatment of nonunion of bone fractures by shock wave therapy
Most bone fractures are consolidated (fused) after 4-6 months or at least radiological signs of progressive fusion are determined on a series of radiographs. If the fracture has not healed by this time, then we are talking about slowing down the consolidation or non-union of the fracture.
Pseudoarthrosis (pseudo-joint) - interruption of the fracture healing process. Between the main fragments of the fracture fibrous or cartilaginous tissue is formed and therefore even after 6-8 months there is no healing of the fracture.
The causes of delayed consolidation and, accordingly, nonunion of bone fractures and pseudoarthrosis are:
- excessive mobility due to inadequate immobilization,
- the presence of a gap between the bone fragments,
- blood supply disorders,
- infection,
- other factors include: old age, nutrition, steroid hormones, anticoagulants, radiation, burns.
These factors lead to pseudoarthrosis, but do not in themselves cause it. The division into delayed consolidation of bone fractures, nonunion and pseudoarthrosis is used as a basis for planning the treatment process. It should be emphasized that prevention is always better than cure!
Therapeutic measures for bone fractures consist of repositioning, strong fixation of fragments for the entire period of fusion and auxiliary methods of treatment (therapeutic exercise, physiotherapy, massage, etc.), aimed at restoring the functional integrity of the damaged limb. The word "auxiliary" here does not diminish their importance and in some cases are as important in restoring bone integrity as surgical treatment. Fixation of bone fragments is achieved through the use of conservative immobilization, as well as surgical techniques.
Rehabilitation measures start as early as possible and include:
- controlled passive movements using CPM (Continious Passive Motion) - long passive movements in the extremities. To do this, use special simulators. Partial weight loading or hardware mechanotherapy is necessary to accelerate the formation of callus. The load is initially a few pounds and increases as you recover. When the radiographs show the formation of sufficient callus, a gradual but steady weekly increase in weight is allowed. Apply active movements in the joints. The set of exercises is carefully selected by specialists for each patient individually. On the upper extremity it is recommended to immediately begin active and passive movements after fixing bone fragments.
- Myostimulation - strengthens muscles and reduces their atrophy and already at this stage creates a sufficient axial load on the bone.
- Shock wave therapy.
In the last 10 years, Awatage Medical Center has been successfully using shock wave therapy, which intensively stimulates angiogenesis (growth of new vessels) and osteogenesis (the process of bone formation) in the area of fracture. The addition of shock wave therapy procedures to the medical complex significantly accelerates the healing of long-growing fractures.
In most cases, SWT is used as a stand-alone method (monotherapy) to accelerate fracture healing and delayed fracture healing. Sometimes 3 procedures are enough to achieve the formation of callus, which is clearly visible on X-rays (see below).
It should be noted that the presence of metal pins in the patient is not a contraindication or obstacle to shock wave therapy in the treatment of delayed fracture fusion.
In our practice, ABSOLUTELY ALL 100% of patients received a positive result - the fusion of bone fractures!
Fracture of the humerus