Ultrasound and shock wave treatment of pseudarthrosis. Meaningful or not and when?

Disorders of bone healing and non-union occur in 5-10% of all fractures. Surgical treatment is the gold standard for treatment of non-unions, although it is associated with high perioperative complication rates ranging from 32% to 73%; therefore, less invasive and more protective treatment options would be desirable. These include biophysical treatment options for non-union, such as ultrasound and shock wave treatment. In the past both non-surgical treatment options achieved good to very good bone consolidation rates taking the indication criteria into consideration, whereby different influencing factors could be identified. Due to the lack of inclusion in the statutory catalogue of services, reimbursement by statutory health insurances is currently a problem in Germany; therefore, further studies are necessary in order to establish and validate biophysical treatment as a supplementary option besides the operative gold standard.