• Falko Dahm, Xaver Feichtinger, Sascha-Mario Vallant, Nicolas Haffner, Wolfgang Schaden, Christian Fialka, and Rainer Mittermayr.
• AUVA Trauma Center Meidling, Kundratstr. 37, 1120, Vienna, Austria. f.dahm@gmx.net.
• Eur J Trauma Emerg Surg. 2022 Aug 1; 48 (4): 3043-3049.

IntroductionWithin the last few decades, focused high-energy extracorporeal shockwave therapy (ESWT) has proven to be an effective alternative to standard of care revision surgery in delayed healing fractures or manifest non-unions in various anatomical regions.Materials And MethodsA retrospective multi-variant analysis of an open prospective, single-armed clinical study was conducted. Patients receiving focused high-energy ESWT for a delayed healing or an apparent non-union of a humeral fracture between January 1999 and December 2015 at a single trauma center were included in the study. Bony healing was defined as cortical continuity in three of four cortices and pain-free force loading and evaluated using CT scans and clinical examination at three- and six-month follow-ups after ESWT.ResultsA total of 236 patients were included. N = 93 (43.8%) showed bony consolidation three months after ESWT and n = 105 (52.5%) after six months. Sub-group analysis showed significantly better healing for the proximal metaphyseal humerus (66.7% after six months, n = 42) compared to the diaphyseal region (48.1%, n = 133) and distal metaphyseal humerus (48.1%, n = 25). Regression analysis indicated significantly increased healing rates for patients of younger ages (p = 0.001) and a fracture diastasis of less than 5 mm (p = 0.002).ConclusionThe findings of this study indicate that ESWT can be considered as a treatment option for a well-selected patient population despite the lower healing rates compared to other anatomical regions.© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

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