Der Unfallchirurg
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Review Meta Analysis
[Physical treatment options with impact on bone healing].
The impact of physical stimulation of a fracture remains unsolved because of the complexity of this process. Differences in the localization and the morphology of the fracture, soft tissue injury, pretreatment and risk factors have an influence on study results, leading to problems in evaluation of physical modulation concerning fractures and nonunions. Extracorporeal shock wave therapy (ESWT) is technically demanding and often associated with local complications including bone and soft tissue stress; however, it is still applied in some centers for the treatment of nonunions. ⋯ For the treatment of delayed unions, a highly rated RCT showed a significantly improved consolidation of midshaft tibial fractures using LIPUS. A systematic review and meta-analysis of nonunions showed positive effects in biologically active lesions, e.g. in hypertrophic pseudarthrosis, leading to a fusion rate of 80%. The consolidation process was better in patients without surgical revision 3-6 months prior to LIPUS.