{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T12:13:52Z","timestamp":1793708032176,"version":"4.6.1"},"reference-count":31,"publisher":"Georg Thieme Verlag KG","issue":"05","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Handchir Mikrochir Plast Chir"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Hintergrund Die ESWT ist eine nichtoperative Option, kann aber auch\n                    erg\u00e4nzend zu einer operativen Therapie (Stabilisierung, Anfrischung,\n                    Defektauff\u00fcllung, Materialentfernung von st\u00f6rendem Fremdmaterial) zur Behandlung\n                    von verz\u00f6gerter (Knochen-)Heilung (VH) und Pseudarthrosen (PA) eingesetzt\n                    werden. Ihre Wertigkeit sowie beeinflussende Faktoren wurden an der oberen\n                    Extremit\u00e4t bisher nicht ausreichend quantifiziert.<\/jats:p><jats:p>\n          Patienten und Methoden Sechzig F\u00e4lle wurden retrospektiv nach Anwendung\n                    einer hochenergetischen, fokussierten ESWT hinsichtlich Ausheilungsrate und\n                    Konsolidierungszeit untersucht. Der Einfluss von Alter, Lokalisation,\n                    Behandlungszeitpunkt, vorausgegangener Therapie sowie einer begleitenden\n                    Behandlung wurde analysiert.<\/jats:p><jats:p>\n          Ergebnisse Bei 70% der F\u00e4lle kam es im Median nach 2,4 (VH) bzw. 2,8\n                    Monaten (PA) zur Ausheilung. Das Durchschnittsalter der Geheilten (VH 44\u2009J., PA\n                    35\u2009J.) und Nichtgeheilten (VH 51\u2009J., PA 37\u2009J.) unterschied sich nicht\n                    signifikant. Die Zeit zwischen Trauma\/OP und ESWT betrug f\u00fcr VH 4,2 Monate bei\n                    Geheilten bzw. 3,7 Monate bei Nichtgeheilten ohne signifikanten Unterschied, bei\n                    PA 27 Monate bei Geheilten wie Nichtgeheilten. Auch Alter und Rauchverhalten\n                    zeigten keinen Einfluss. Die Ausheilungsrate war am h\u00f6chsten an\n                    Mittelhandknochen\/Finger\/Daumen (91%), gefolgt von Unterarmschaft (88%),\n                    Epi-\/Metaphyse des Unterarms (67%) und zuletzt Handwurzelknochen (59%). Nach\n                    konservativer Vorbehandlung heilten 55%, bei&gt;2 Voroperationen 67%, ohne\n                    Vorbehandlung 73% und nach einer Voroperation 75%. Die weitere Analyse\n                    hinsichtlich der operativen Vorversorgung ergab nach alleiniger ORIF 85%, ohne\n                    Voroperation 64% und nach ORIF mit Knochenanfrischung\/-transplantation 57%\n                    Heilungsrate. Bei intraoperativer ESWT kombiniert mit\n                    Knochendebridement\/-transplantation+ORIF heilten 67%, kombiniert mit einer\n                    alleinigen ORIF 86%. Bei alleiniger ESWT oder mit nur minimalen Ma\u00dfnahmen\n                    (Materialentfernung) konsolidierten 70%.<\/jats:p><jats:p>\n          Schlussfolgerung Die ESWT ist in jedem Stadium der Knochenheilungsst\u00f6rung\n                    gleich wirksam. Die Prinzipien von Stabilit\u00e4t und Auff\u00fcllung bei vorhandenen\n                    Knochendefekten m\u00fcssen auch bei der Anwendung der ESWT ber\u00fccksichtigt werden,\n                    dann wirkt die ESWT alleinig oder kombiniert mit einer Operation gleicherma\u00dfen.\n                    Der negative Einfluss von Knochendefekten\/-resorption ist auch mit ESWT noch\n                    nachweisbar. Ebenso ist die Behandlung des Kahnbeins problematischer als \u00fcbrige\n                    Lokalisationen. Eine vorangegangene Operation stellt keinen negativen Faktor\n                    dar, auch wenn Fremdmaterial einliegt.<\/jats:p>","DOI":"10.1055\/a-2406-5858","type":"journal-article","created":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T02:14:58Z","timestamp":1727489698000},"page":"350-358","source":"Crossref","is-referenced-by-count":3,"title":["Hochenergetische, fokussierte extrakorporale Sto\u00dfwellentherapie\n                    (ESWT) bei Knochenheilungsst\u00f6rungen von Unterarm und Hand"],"prefix":"10.1055","volume":"56","author":[{"given":"Eva-Kristina","family":"Liedl","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Handchirurgie, Rh\u00f6n Klinikum Campus Bad Neustadt, Bad\n                    Neustadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"van Schoonhoven","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Handchirurgie, Rh\u00f6n Klinikum Campus Bad Neustadt, Bad\n                    Neustadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Josef","family":"Prommersberger","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Handchirurgie, Rh\u00f6n Klinikum Campus Bad Neustadt, Bad\n                    Neustadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"M\u00fchldorfer-Fodor","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Handchirurgie, Rh\u00f6n Klinikum Campus Bad Neustadt, Bad\n                    Neustadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/00003086-200106000-00012.","article-title":"Extracorporeal shock wave therapy of nonunion or delayed osseous union","volume":"387","author":"W Schaden","year":"2001","journal-title":"Clin Orthop Relat Res"},{"key":"ref2","first-page":"16","article-title":"Viel Bedarf, aber immer noch keine zufriedenstellenden L\u00f6sungsans\u00e4tze","volume":"8","author":"W Schaden","year":"2013","journal-title":"JATROS Unfallchirurgie & Sporttraumatologie"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"846","DOI":"10.2106\/JBJS.I.00653","article-title":"Shock wave therapy compared with intramedullary screw fixation for nonunion of\n                    proximal fifth metatarsal metaphyseal-diaphyseal fractures","volume":"92","author":"J P Furia","year":"2010","journal-title":"J Bone Joint Surg Am"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s13018-017-0667-z","article-title":"Radial extracorporeal shock wave therapy is efficient and safe in the treatment\n                    of fracture nonunions of superficial bones: a retrospective case series","volume":"12","author":"P Kertzman","year":"2017","journal-title":"J Orthop Surg Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"2589","DOI":"10.2106\/JBJS.H.00841","article-title":"Extracorporeal shock-wave therapy compared with surgery for hypertrophic\n                    long-bone nonunions","volume":"91","author":"A Cacchio","year":"2009","journal-title":"J Bone Joint Surg Am"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1002\/stem.1356","article-title":"Shockwaves induce osteogenic differentiation of human mesenchymal stem cells\n                    through ATP release and activation of P2X7 receptors","volume":"31","author":"D Sun","year":"2013","journal-title":"Stem Cells"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1016\/S0736-0266(03)00104-9","article-title":"Shock wave therapy induces neovascularization at the tendon-bone junction. 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Chirurgie"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2406-5858.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T16:42:13Z","timestamp":1730824933000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2406-5858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9]]},"references-count":31,"journal-issue":{"issue":"05","published-online":{"date-parts":[[2024,9,27]]},"published-print":{"date-parts":[[2024,9]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2406-5858","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0722-1819","1439-3980"],"issn-type":[{"value":"0722-1819","type":"print"},{"value":"1439-3980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9]]}}}