Radial Pressure Waves: The Invisible Frontier Between Bone Healing and Nonunion
Mary S Chávez1*, Juan Leal2, Raúl Chirinos3
1Orthopedic Surgery and Traumatology, Advanced Program in Shock Waves. Vivir Mejor Institute, Orthopedic Surgery and Traumatology and Shock Waves Unit, Valencia, Venezuela. ORCiD: 0000-0001-7425-7894
2Reconstructive Orthopedic Surgery, Advanced Shock Wave Program. Vivir Mejor Institute, Orthopedic Surgery and Traumatology and Shock Waves Unit, Valencia, Venezuela. ORCID: 0009-0002-8083-6491.
3Arthroscopic Surgery, Advanced Program in Shock Waves, Faculty of Health Sciences, University of Carabobo, Valencia, Venezuela. ORCiD: 0000-0003-1964-7528.
*Corresponding Author: Mary S Chavez, Orthopedic Surgery and Traumatology, Advanced Program in Shock Waves. Vivir Mejor Institute, Orthopedic Surgery and Traumatology and Shock Waves Unit, Valencia, Venezuela. ORCiD: 0000-0001-7425-7894
https://doi.org/10.58624/SVOAOR.2025.05.018
Received: September 30, 2025
Published: October 29, 2025
Citation: Chavez M, Leal J, Chirinos R. Radial Pressure Waves: The Invisible Frontier Between Bone Healing and Nonunion. SVOA Orthopaedics 2025, 5:5, 108-114. doi: 10.58624/SVOAOR.2025.05.018
Abstract
Introduction: Nonunion and delayed bone healing are common complications of fractures, particularly in long bones, with significant functional, social, and economic repercussions. Surgical treatment is considered the gold standard but often requires multiple procedures and entails high costs. In this context, radial extracorporeal shockwave therapy (rESWT) emerges as an outpatient, minimally invasive, and cost-effective alternative capable of stimulating bone consolidation.
Objectives: To evaluate the experience with rESWT in the management of nonunion and delayed bone healing. Specifically, to characterize patients according to demographic and clinical variables; to describe pain evolution using the visual analog scale (VAS); to compare radiological changes using the Montoya scale at one, three, and six months; and to determine patient functionality and satisfaction.
Methods: A descriptive, longitudinal, and prospective study was conducted in 15 patients treated at the Instituto Vivir Mejor between January 2022 and January 2025. The protocol included rESWT (BTL 5000 SWT Power, 4 bar, 15 Hz, 4,000 impulses, five weekly sessions), nutritional supplementation, and physiotherapy. Variables analyzed included sociodemographic characteristics, pain (VAS), radiological consolidation (Montoya scale), functionality, and satisfaction.
Results: Sixty percent of patients were young adults (19–40 years), with a predominance of males (53.3%). The most frequent diagnosis was delayed union (80%). Pain decreased significantly, from 33.3% with moderate pain at baseline to 93.3% pain-free at six months (p < 0.001). Radiologically, 93.3% reached Montoya grade 4 at six months (p < 0.001). Functionality improved progressively, with 100% of patients no longer requiring assistive devices and 93.3% reporting being “very satisfied” at six months.
Conclusions: rESWT, combined with nutritional support and physiotherapy, appears to be a safe, effective, and minimally invasive alternative in superficial nonunions and delayed consolidations. Its benefits include pain reduction, accelerated bone healing, improved functionality, and high patient satisfaction. Controlled, multicenter studies are recommended to confirm these findings and standardize clinical protocols.
Keywords: Nonunion; Bone Healing; Radial Shockwave Therapy; Non-Invasive Therapy; Traumatology.