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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2001 December;52(6):261-8
Extracorporeal lithotripsy in the treatment of bone pseudoarthrosis
Russo S., Amelio E., Galasso O., Corrado B., Cugola L.
Background. Shock wave therapy, originally devised to break up renal calculi, in last years has been successfully employed in orthopedics and traumatology. The efficacy and the fast effect have won it an extensive place in the treatment of bone pseudoarthrosis and tendon diseases, especially in athletes. A retrospective study of five-years experience in the treatment of bone pseudoarthrosis by high-energy shock waves, is reported.
Methods. Since 1995 up to October 2000, three hundred and ninety-nine patients suffering from bone pseudoarthrosis have been treated All patients have been treated at the ESWT Units of the Orthopedic Departments, University of Naples Federico II and University of Verona. Prior to undergo shock wave therapy patients have been submitted to clinical and radiological examinations. All cases have a minimum follow-up of 6 months, some cases showed an 8-year follow-up. Electromagnetic coil lithotriptors provided with in-line radiographic and ultrasound aiming (Modulith SL-20 and Modulith SLK by Storz Medical) have been used. The device used in Verona was provided with a virtual aiming system, named lithotrack system.
Results. The success rate reported was high even if it changed on the basis of pseudoarthrosis localisation. No side effects were observed.
Failures are discussed also on the basis of in vitro and in vivo studies of unsuccessful treatments due to inadequate development of cavitation during shock wave therapy.
Conclusions. The success rate in the treatment of bone pseudoarthrosis is high. Reasons of failed treatments have been hypothesised. The cavitation development seems to play a primary role for the effectiveness of the therapy. Shock wave technique has several advantages over other treatments: it does not give any complication, it's a non-operative, painless treatment with an excellent compliance (rarely anesthesia is required), it can be used both before operative methods and after unsuccessful surgical interventions for fractures, the time required for a single application is short (15/20 minutes), its sanitary cost is not exorbitant mainly because the treatment doesn't require hospitalisation. Due to the above mentioned reasons and on the basis of the results achieved shock wave therapy is a useful technique the specialist should always consider to treat such disease.