ORTHOPAEDIC CASES TREATED BY EXTRA CORPOREAL SHOCCK WAVE THERAPY

Abstract

Shockwave treatment in our unit is provided in conjunction with our Urological colleagues. Shock Wave Therapy has been used as a last option in patients with difficult and chronic Orthopaedic conditions with an informed consent for all patients.

Material and Methods: 28 patients from Ealing Hospital and West Middlesex Hospital were referred to The Lithotripsy unit at Charing Cross Hospital for Shock wave therapy.

Patients were consented by the Orthopaedic surgeon and the treatment was administered by urologist

The cases included:

• 4 Humeral fractures: 1 Case in HIV +ve 19 years old

• 5 Femoral non-union: 1 case bilateral in Osteogenesis imperfecta

• 4 Tibial non-union: 1 Recurent Fracture in 65 years old man

• 2 Osteochondritis of the Talus

• 2 Osteochondritis of the knee

• 4 Scaphoid fractures: 1 case had been fixed and grafted.

• Medial Epicondyle fracture non union

• 5^th Metacarpal Fracture

• Trochanteric Bursitis

• Tennis Elbow

• 4 Planter fasciitis

  • – The Shock wave Machine used is Storz SLX – F2 Electromagnetic shock wave generator which focus the shock wave low energy high frequency in focal zone with no harm to other tissues. Frequency 4 htz = 4 shockwave/sec

  • – Energy level 1–3 generate pressure value in the focal area of 5–30 megapascal

  • – Size of focal zone 9X 50 mm or 6X 28 mm

  • – Total shock wave applied per session 2000 to 3000 shock

  • – large focus and small focus were used in fracture of large bones and small bones respectively. Most of cases required 2–3 session with 4–6 weeks interval.

  • – in Soft tissue Treatment Less energy was used and patients required 1 to 2 sessions.

Results: There was complete resolution of symptoms in the 4 cases of soft tissues.

• – Clinical and radiological union in 3 of the 4 Humeral Fracture including HIV+ve and in 2 of 3 tibial fracture and 1 of 2 scaphoid.

• – 50% pain relief in Psedo arthrosis

• – Union is promoted by Cellular stimulation and pain relief is by unknown mechanism but explained by increase vascularity and neuro-modulation.

• – None of the patient’s have so far required subsequent operative interventions, several had residual symptoms.

Discussion: Shock wave therapy is a new consevative treatment modality used in orthopaedic as the last option before surgery but there is a need for RCT.