Keywords
delayed union of bone fractures
shock wave therapy
How to Cite
Abstract
Relevance. Violation of bone formation processes continues to occupy a relatively high level, reaching 2.7-27.1%, so the search for new methods for their treatment and prevention remains relevant. One of these methods is extracorporeal shock wave therapy. Views on the influence of the extracorporeal shock wave therapy on the processes of bone formation significantly differ.
Objective: to study the effect and mechanism of action of shock wave therapy on the processes of reparative osteogenesis in an experiment and the effect of the method on delayed union of bone fractures and pseudarthrosis in clinical conditions.
Materials and Methods. In an experiment on rabbits, after a standard model of a perforated defect in the proximal tibial metadiaphysis on the days 3, 6, 9, and 12 after injury; the injury site of the animals of the main group was influenced with radial low-energy shock waves. The results of treatment were monitored with the help of clinical, radiological and histomorphological methods. The clinical section included 136 patients with union fracture disorder of long bones who had previously undergone conservative treatment or osteosynthesis. All patients underwent 1-3 sessions of extracorporeal shock wave therapy with evaluation of the results on 3, 6, and 12 months after treatment using the data of X-ray examinations and the Neer – Crantham – Shelton functional scale.
Results. The studies showed that rabbits of the main group morphologically had a greater thickness and density of formed bone crossbars at the site of the proximal tibial metadiaphysis defect in a month after extracorporeal shock wave therapy, and after 45 days, a greater number of cases of restoration of its cortical layer was notified (p<0.05). Three months after treatment of patients with delayed union of bone fractures with extracorporeal shock wave therapy, consolidation was detected radiologically in 89.4% of cases; this indicator remained almost unchanged in the subsequent periods of the study. Three months after treatment of patients with pseudoarthrosis of the bones with extracorporeal shock wave therapy, radiological consolidation was detected in 46.1% of patients, after 6 months – in 75.3%, after 12 months – in 80.9%. At the end of the study, scores on the Neer – Crantham – Shelton Functional Scale also improved significantly.
Conclusions. The results of the studies allow us to conclude that extracorporeal shock wave therapy is an effective non-invasive method for the treatment of delayed union of bone fractures and pseudarthrosis and is an alternative to surgical interventions.
References
Kalashnikov AV, Chip YeE, Kalashnikov OV, Chalaydyuk TP. Determination of the Efficiency of Using Different Methods of Treating Fractures of the Proximal Tibia. Herald of Orthopaedics, Traumatology and Prosthetics. 2019;4(103):25-38. DOI: 10.37647/0132-2486-2019-103-4-28-34 (in Ukraine).
Mansyrov AB, Lytovchenko VO, Gariachyi YeV. Complications of Intramedullary Blocking Osteosynthesis of Bones of Limbs and Ways to Prevent Them. Herald of Orthopaedics, Traumatology and Prosthetics. 2020;1(105): 35-43. DOI: 10.37647/0132-2486-2020-105-2-35-42. (in Ukraine).
Moya D, Ramón, S, Schaden, Wang CJ, Guiloff L, Cheng JH. The Role of Extracorporeal Shockwave Treatment in Musculoskeletal Disorders. The Journal of Bone and Joint Surgery: Feb.7, 2018;100(3): 251-263. DOI: 10.2106/JBJS.17.00661.
Matsuda M, Kanno H, Sugaya T, Yamaya S, Yahata K, Handa K, Shindoc T. Low-energy extracorporeal shock wave therapy promotes BDNF expression and improves functional recovery after spinal cord injury in rats. Experimental Neurology. 2020; 328: 113251-57. DOI: 10.1016/j.expneurol.2020.113251.
Qingxi Zhang, Yu Zhao, Dan Xing, Jianhao Lin. Global Research Trends in shock wave for Therapy from 1990 to 2019: A Bibliometric and Visualized Study. Biomed Res Int. 2021, Jan 7, 21:1372-1384. DOI: 10.1155/2021/3802319.
Vasilyev AY, Egorova EA. Extracorporeal shock wave therapy in the treatment of injuries and diseases of the musculoskeletal system M. “Medicina”, 2005. 95s. (in Russian).
Kostenko EV, Zuev DS, Zaitseva TN. The role of extracorporeal shock wave therapy in thecombined restorative treatment of the patients presenting with myofascial pain syndrome (a clinical review). Problems of balneology, physiotherapy, and exercise therapy. 2018;95(4):62-68. DOI: 17116/kurort20189504162 (in Russian).
Puetzler J, Mistrey A, Everding J, Raschke M, Arens D, Zeiter S. Focused high-energy extracorporeal shockwaves as supplemental treatment in a rabbit model of fracture-related infection. J. Orthopaedic Research. 2020 Jun; 38(6):1351–1358. DOI: 10.1002/jor.24565.
Kylymniuk LO. Forecasting of fracture healing complications and clinical and experimental substantiation of early diagnosis and choice of treatment method. Avtoref. cand. dis.,Vinnytsia 2019, 14s. (in Ukrainian).
Augat P., Claes L., Suger G. In vivo effect of shock-waves on the healing of fractured bone (Bristol. Av on). 2018;(29):374-8. DOI: 10.1016/0268-0033(95)00009-a.
Hertsen HI, Se-Fei, Ostapchuk RM, Lisovyi OV, Slabospytskyi AV. Extracorporeal shock wave therapy effect on bone fracture healing. (review of literature). Herald of Orthopaedics, Traumatology and Prosthetics. 2017; 1:61-65. (in Ukrainian).
Маgomedov AМ, Gertsen GI, Se Fey, Кuzub ТА, Кrinitskaya ОF. Impact of radial shock wave therapy of a low frequency on metabolic processes in the bone tissue in traumatic tibial defects inexperiment. Klinichna Hirurgiya. 2016; 4:64-66. (in Russian).
Se-Fei. Immune blood cells under the influence of extracorporeal shock wave therapy in bone trauma. Visnyk Ukrainskoi medychnoi stomatolohichnoi akademii. 2016;16,4 (56):276-280. (in Russian).
Thomas PR, Richard EB, Christopher GM. Principles of Fracture Management – Stutgart, 2001. – С. 753-765.
Wähnert D, Stolarczyk Y, Hoffmeier KL, Raschke MJ, Hofmann GO, Mückley T. The primary stability of angle-stable versus conventional locked intramedullary nails. International Orthopaedics. 2011;36(5):1059-64. DOI: 10.1007/s00264-011-1420-6.
Hertsen GI, Se-Fei, Ostapchuk RN, Malokhat’ko SI, Kostenko AV, Zherebchuk VV. Effect of Radial Extracorporeal Shock Wave Therapy on the Healing of Experimental Bone Defect. Herald of Orthopaedics, Traumatology and Prosthetics. 2016; 4 (605):11-16. (in Russian).
Se Fei. Effect of Radial Shock Wave Therapy on Reparative Regeneration of Bone Tissue. Avtoref. kand., dis. Kiev, 2017, 20s. (in Ukranian).
Maier M, Milz S, Tischer T, Münzing W, Manthey N, Stäbler A, Holzknecht N. Influence of extracorporeal shock-wave application on normal bone in an animal model in vivo. The Journal of Bone and Joint Surgery. British. 2002;84-B(4):592-9. DOI: 10.1302/0301-620x.84b4.11621.
Vasilevich SV, Kurchenko SN. Experimental Evaluation of the Effect of Radial Shock Wave Therapy on the Formation of Piezoelectric Effects in Bone Tissue. Biomedicinskiy jornal “Medline.ru”, 2021;22, 9:119-133. (in Russian).
Garilevich BA, Semenov AA, Gurevich KG, Nagornev SN, Radchenko SN, Puzyreva GA. Shock-wave therapy: status update on the problem and possibilities of application in clinical practice. Kursk. Scientific and Practical Bulletin “Man and His Health”. 2017;(3):11-18. DOI: 10.21626/vestnik/2017-3/02.
This work is licensed under a Creative Commons Attribution 4.0 International License.