Treatment of the unhealed fractures by focused shock wave therapy (ESWT)

For easier explanation about the effects of the focused shock wave therapy on the muscles and bones (musculoskeletal system), we will use your imagination. It is about physical force stimulating the bone cells and osseous tissues (substantia spongiosa - fibrous surface which create a supportive “net”) which makes the bones harder.


Regular application of the acoustic shock waves with a specific frequency leads to increased metabolic activity of the cells, cell growth (cytoproliferative effect) and densing the number on the cm2 . At the same time the shock waves have a anti-inflammatory effect, they basically stimulate the autoimmunity function of the organism, regenerational ability of the tissue and they lower the pain as well. It is proved that the effect of acoustic waves leads to growth of new capillaries of the blood stream into the tissues, which speeds up the healing process and at the same time it also leads to vasodilatation (widening of the blood vessels) and thus also increasing the partial pressure of the oxygen pO2 in the tissues, which is especially important by a necrotic tissue (complicated fractures, venous ulcers,...).

At the same time it forms a “P” substance, which works against the pain (analgesic effect) and it also has a growth effect. Increased metabolic tissue (chemical transformation) supports the removal of the catabolites from the damaged tissue. At the same time there is a flow of nutrients and oxygen and the regeneration of the tissues improves. The production of the inflammatory enzymes in the tissues subdues, and the calcifications dissolve (for example in the shoulder joint) or it stops calcification completely (formation of calcium residue).

Application of the shockwave therapy has been proved to treat:

  • Inflammation of the bone
  • Speeding up the unhealed fractures
  • Bone fracture affected by avascular necrosis

The speeded recovery enables a fast return back into the daily life and sport activities.


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ESWT is a proven alternative treatment method besides the surgical treatment, for healing the unhealed fractures and pseudoarthrosis. German research team of doctor Frank Bätje from Hannover has researched 381 cases between the years 2001-2010 of incorrectly healed fractures. After application of ESWT, 63% of the cases have fully recovered. From which 66% had incorrectly healed fractures and 47% of the cases have been after arthrodesis (artificial ossification of the joints).

Another successful example of the ESWT in the treatment of the unhealed or badly healed fractures is the study of scientists Angel Cacchia and his team from 2009, when they compared the effectivity of the ESWT therapy and surgical treatment in the mentioned problematics above.


126 patients with a long-term arthrodesis were randomly split into groups receiving either the focused shockwave treatment with different machines (group 1 and 2), or surgical treatment (group 3). Patients in the shockwave group received four treatments with 4000 impulses of the shock waves with a density of the energetic flux 0,40 mJ / mm2 (group 1), and 0,70 mJ / mm2 (group 2). Patients in all three groups had similar demographic characteristics and lasting arthrodesis. Radiographic results (primary goal) and clinical results were made before the therapy, and then after three, six, twelve, and twenty four months after the treatment.


X-ray results did not differ between these 3 groups of patients! Which means, the treatment was successful by all three approaches.

After 6 months, 70% cases of arthrodesis in the first group, 71% in the second group, and 73% in the third group have fully healed. Clinical tests, were 3-6 months after the treatment much better by both groups which were treated with shock wave therapy than by the surgically treated patients. However in the long span of time from 12 to 24 months after the treatment, there were no differences between the groups, except for the DASH measure outcome (measuring the level of disability, restriction of various activities, and subjective manifestations of the symptoms), which are significantly differing between the first/second and third group after 12 months after the therapy.


Therapy with extracorporeal shock wave is as effective as surgical solution during stimulation of the long bones in the place of hypertrophic arthrodesis, but it brings significantly better short term clinical results. It is therefore verified, equivalent and non-invasive alternative solution for these problems.

 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: CACCHIO, A.; GIORDANO, L.; COLAFARINA, O.; ROMPE, J.; TAVERNESE, E.; IOPPOLO, F.; FLAMINI, S.; SPACCA, G.; SANTILLI, V. Extracorporeal shock wave therapy compared with surgery for hypertrophic long-bone non-unions. Journal Bone Joint Surgery Am. 2009; 91:2589-2597
BÄTJE, F. Extracorporeal Shockwave Therapy (ESWT) in Osseous Non-Unions – a German Cohort Study. [online]. 2011 [cit. 2017-19-1]. Dostupné na

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