Justification of differential choice of treatment method for nonunion of the long bones
Summary. Aim — to develop criteria for a differentiated approach to the extracorporeal shockwave therapy of nonunion, taking into account their ability to biological repair. Materials and methods. 23 patients with nonunion of the long bones have been examined. Based upon the healing potential of pseudarthrosis, all patients were divided into investigated group, which consisted of 16 (69.56%) patients with nonunion with saved ability to biological repair, and control group, which included 7 (30.43%) patients with nonunion without the ability to biological repair. The results of the treatment have been evaluated during the initial treatment and after the course of nonoperative stimulation of reparative regeneration by using of extracorporeal shockwave therapy. Results. Patients in the investigated group showed significantly better outcomes in the remote period of the characteristics of pain (p=0.000001), limitation of movement (p=0.0005), radiographic parameters (р0.05). Conclusions. Thus, the necessity of a differentiated approach to the use of extracorporeal shockwave therapy in nonunion has been established, taking into account their ability to biological repair and its low efficiency with nonunion without the ability to biological repair.
Key words: nonunion, fracture healing disorders, extracorporeal shockwave therapy, reparative regeneration, stimulation of reparative osteogenesis, ability to biological repair, fractures of tubular bones.
- Ivanov O.M., Berezka M.I., Lytovchenko V.O., Hariachyi Ye.V. (2015) Rezultaty vykorystannia reparatyvnoi metodyky likuvannia dysreheneratsii kistkovoi tkanyny. Sci. J. «ScienceRise», 10/3(15): 5–11.
- Cheng J.H., Wang C.J. (2015) Biological mechanism of shockwave in bone. Int. J. Surg., 24(Pt. B): 143–146.
- Cherkes-Zade D., Monesi М., Causero A., Marcolini М. (2003) Хирургическое лечение переломов дистального отдела бедренной кости с использованием системы LISS (пер. с англ.) (https://elibrary.ru/item.asp?id=17033180).
- Everding J., Freistühler M., Stolberg-Stolberg J. et al. (2017) Extracorporal shock wave therapy for the treatment of pseudarthrosis: new experiences with an old technology. Unfallchirurg., 120(11): 969–978.
- Gandhi S.J., Rabadiya B. (2017) Bone scan in detection of biological activity in nonhypertrophic fracture nonunion. Ind. J. Nucl. Med., 32(4): 326–329.
- Haffner N., Antonic V., Smolen D. et al. (2016) Extracorporeal shockwave therapy (ESWT) ameliorates healing of tibial fracture non-union unresponsive to conventional therapy. Injury, 47(7): 1506–1513.
- Kertzman P., Császár N.B.M., Furia J.P., Schmitz C. (2017) Radial extracorporeal shock wave therapy is efficient and safe in the treatment of fracture nonunions of superficial bones: a retrospective case series. J. Orthopaed. Surg. Res., 12: 164.
- Lohrer H., Nauck T., Korakakis V., Malliaropoulos N. (2016) Historical ESWT paradigms are overcome: a narrative review. BioMed. Res. Int., 1–7.
- Neer C.S. 2nd, Grantham S.A., Shelton M.L. (1967) Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J. Bone Joint Surg. Am., 49(4): 591–613.
- Niikura T., Lee S.Y., Sakai Y. et al. (2014) Comparison of radiographic appearance and bone scintigraphy in fracture nonunions. Orthopedics, 37: e44–e50.
- Schaden W., Mittermayr R., Haffner N. et al. (2015) Extracorporeal shockwave therapy (ESWT)-First choice treatment of fracture non-unions? Int. J. Surg., 24 (Pt. B): 179–183.
- Weber B.G., Cech O. (1976) Pseudarthrosis. Grune and Stratton, New York, р. 319–323.