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.
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 5th 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.
– 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.
Patients Symptoms Treatment received Spinal Operations Body Diagram for shading the site of pain Final outcome Patient Satisfaction
– 76 patients 66% of the patients who replied “were satisfied” with the surgery. – 38 patients 33% of the patients who replied were not satisfied. – 58 patients did not reply as they were not interviewed. There were no significant post-operative neurogenic complications, such as cauada equina syndrome or severe leg weakness interfering with standing and walking retirement. There was always a temporary relief followed by deterioration of symptoms after a period ranging between 1–2 years.
We report the results of limb salvage for non-metastatic osteosarcoma of the distal tibia using resection arthrodesis, autogenous fibular graft and fixation by an Ilizarov external fixator. In six patients with primary osteosarcoma of the distal tibia who refused amputation, treatment with wide In five patients sound fusion occurred at a mean of 13.2 months (8 to 20) with no evidence of local recurrence or deep infection at final follow-up. The mean post-operative functional score was 70% (63% to 73%) according to the Musculoskeletal Tumour Society scoring system. All five patients showed graft hypertrophy. Union of the graft was faster in cases reconstructed by vascularised fibular grafts. One patient who had a poor response to pre-operative chemotherapy developed local tumour recurrence at one year post-operatively and required subsequent amputation.
