Superficial nonunions
CONSULT TREATMENT PROTOCOL

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Nonunion refers to the failure of bone fractures to achieve cortical continuity on radiographic studies.

The prevalence of nonunion of all fracture types ranges from 2.5% to 46% and the complication places substantial economic burdens on health systems. Surgical fracture stabilization using bone grafts and internal/external fixation has remained the gold standard for treating fracture nonunions.

However, these procedures often lead to serious complications including deep infections, persistent wound drainage, hematoma formation, sensory loss, persisting pain and nonunions. Hence, there remains a need for efficient therapies that will bring better results more quickly and without major complications. Over the past decades, focused extracorporeal shock wave therapy (fESWT) has emerged as an efficient, non-invasive and cost-effective alternative to surgery in the treatment of fracture nonunions.

A total of 40 studies (as of Juli 31, 2017) have shown an overall success rate of approximately 76% after six months when treating fracture nonunions with fESWT, without major complications. Among these 40 studies were one randomized controlled trial with a success rate of 71% after six months, two cohort studies comparing fESWT with surgery, with success rates of 91% and 79% after six months, and 36 case series without control group, with success rates between 39% and 100% after six months