Extracorporeal shockwave therapy in bone fractures: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not quantified - no pooled analysis reported

• Primary Outcome: Most studies demonstrated positive effects of ESWT on bone healing

• Nnt Or Sensitivity: Not calculated due to lack of quantitative synthesis

• Confidence Interval: Not reported

Clinical Application

Non-invasive outpatient procedure, but requires specialized equipment and trained operators ESWT devices are TGA-approved for musculoskeletal conditions; however, specific PBS coverage for fracture treatment may be limited. Would require integration with orthopaedic services and physiotherapy departments Patients with bone fractures, particularly those with delayed union or nonunion

Abstract

INTRODUCTION: The increasing incidence of fractures and cases of delayed union or nonunion has encouraged the search for non-invasive therapies. Extracorporeal shockwave therapy (ESWT) has been proposed as a strategy to stimulate bone regeneration and improve fracture healing. MATERIALS AND METHODS: A systematic review was conducted following PRISMA guidelines, with searches performed in PubMed, Scopus, Web of Science, and Embase (2005-2025). Clinical studies evaluating ESWT for fracture treatment with radiographic assessment of bone healing and the presence of a control group were included. RESULTS: A total of 834 studies were initially identified, of which 7 were included in the final analysis. Most studies demonstrated positive effects of ESWT, including improved bone healing, pain reduction, and functional recovery. However, there was considerable heterogeneity in treatment protocols and relatively small sample sizes. CONCLUSION: ESWT shows potential as a non-invasive therapy to stimulate fracture healing, particularly in cases of delayed union or nonunion. However, further controlled clinical trials and standardized protocols are needed to confirm its clinical effectiveness.

References

1. 1.Santos, T. I. R., Souza E Silva, L. C., Bonifacio, M., Campos Melo, C. M., Sena, B. G., Simões, M. C., Risso Parisi, J., da Silva Fernandes, A. C., Akashi, H. M., de Oliveira, F., & Renno, A. C. M. (2026). Extracorporeal shockwave therapy in bone fractures: a systematic review. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1016/S0736-0266(03)00104-9