Clinical investigation of extracorporeal shock wave therapy combined with kinesitherapy on the treatment of delayed union of tibia and fibula fractures.

Abstract

Objective: To investigate the therapeutic efficacy of extracorporeal shock wave therapy (ESWT) combined with kinesitherapy (KT) for the treatment of delayed union of tibia and fibula fractures.

Methods: A total of 68 patients with delayed healing of tibiofibular fractures were enrolled. These patients were divided into three groups: control, ESWT, and ESWT+KT. All patients underwent standard surgical treatment following the fracture. Patients in the ESWT group received shockwave therapy twice a week for 4 months, while those in the ESWT+KT group received additional exercise therapy twice a week over the same duration. The control group did not receive any specific intervention during this period. The pain levels of patients in all three groups were assessed using the Numerical Rating Scale (NRS) before and after treatment. Bone repair and callus formation were evaluated using the Lane-Sandhu and Fernandez-Esteve X-ray grading scales before and after treatment. Additionally, walking ability was assessed using the Functional Ambulation Classification (FAC), Hoffer walking ability grade, and Holden walking ability grade before and after treatment.

Results: No significant differences were observed in patient baseline characteristics across the three groups (P > 0.05), indicating comparability among groups. Post-treatment, improvements were noted in the NRS, Lane-Sandhu X-ray scale, Fernandez-Esteve X-ray scale, FAC level, Hoffer grade, and Holden grade in all three groups compared to their respective pre-treatment values (P < 0.05). Notably, the Lane-Sandhu X-ray scale, FAC level, Hoffer grade, and Holden grade showed significant improvements in the ESWT+KT group after treatment compared to the control group (P < 0.05). Additionally, the ESWT group demonstrated significant improvements in FAC level and Holden grade compared to the control group after treatment (P < 0.05).

Conclusion: ESWT can enhance the walking function in patients with delayed union of tibia and fibula fractures. ESWT combined with KT demonstrates superior efficacy compared to monotherapy, as it not only improves walking function but also promotes bone healing.