Successful Treatment of a Nonunion Fracture of the Femur With Extracorporeal Shockwave Therapy: An Evidence-Based Case Report

Nonunion fractures, especially of the femur, pose a considerable difficulty in orthopedic management due to their propensity to result in enduring physical disability and psychological complications. Conventional surgical procedures, although efficacious, may entail difficulties and have a reduced success rate for atrophic nonunions. Extracorporeal shockwave therapy (ESWT) has arisen as a viable non-invasive option, facilitating bone regeneration via many biological mechanisms. This case report describes the management of a 40-year-old male patient with a distal-third open femoral fracture resulting from a motor vehicle accident. Despite receiving open reduction internal fixation and an extensive rehabilitation regimen, the patient had little callus development after six months. ESWT was commenced once weekly for 23 weeks, combined with ultrasonic low-intensity pulsed ultrasound (LIPUS) therapy and leg extension exercises. The patient had full callus formation on the femur and made a full recovery. The comprehensive literature evaluation demonstrates that ESWT can achieve a healing rate of around 73% for nonunion femoral fractures. The therapy's effectiveness is due to its capacity to induce osteogenic responses, promote osteoblast development, and suppress osteoclast production. This non-invasive method diminishes the necessity for supplementary surgical interventions and related complications. Additional research is required to develop standardized methods and refine therapy parameters, guaranteeing consistent and dependable results across various patient groups.