Treatment of delayed union of the forearm with extracorporeal shockwave therapy: a case report and literature review

Front Endocrinol (Lausanne). 2023 Nov 15:14:1286480. doi: 10.3389/fendo.2023.1286480. eCollection 2023.


Compared to other long bones, forearm fractures are particularly challenging due to the high rate of complications. These include malunion, delayed/nonunion, wrist and elbow movement reduction, and pain. Surgical procedure is considered the gold standard for managing delayed union and nonunion of the long bones. However, in the last decades, extracorporeal shockwave therapy (ESWT) has emerged as an effective and less invasive approach to enhance bone regeneration and fracture healing, avoiding major complications of surgical procedures. In contrast to the broad literature reporting good clinical results of ESWT in the treatment of nonunions, there is currently limited evidence regarding the clinical application of shock waves on long bone delayed fractures, particularly those of the forearm. In the present paper, we report a case of delayed bone healing of the diaphyseal region of the ulna treated with focused ESWT. The successful case experienced bone healing at the fracture site in less than 3 months after initial ESWT treatment. Acknowledging the limitation of reporting a case report, however, the remarkable clinical results and the absence of side effects contribute valuable information in support of the use of ESWT as an effective alternative to standard surgery for forearm fractures.

Keywords: bone healing; delayed union fracture; extracorporeal shockwave therapy; forearm; long bone fracture.

Publication types

  • Review
  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bone Regeneration
  • Extracorporeal Shockwave Therapy*
  • Forearm
  • Forearm Injuries* / therapy
  • Fracture Healing
  • Fractures, Bone* / therapy
  • Fractures, Ununited* / surgery
  • Humans

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by the University of Pisa (Fondi di Ateneo) and by the Center for Rehabilitative Medicine “Sport and Anatomy”, University of Pisa.