The effect of shockwaves on mature and healing cortical bone.

It has been proposed that high energy shockwaves could be used to create microfractures in cortical bone. This quality might be exploited clinically to perform closed osteotomies and promote healing in nonunion (15). However, no study has previously documented the effect of shockwaves on cortical bone "in vivo". We report an investigation designed to demonstrate the effect of shockwaves on mature cortical and healing bone. An osteotomy was performed on the tibiae of 37 lambs; two weeks later the operation site was exposed to shockwaves. Three weeks later the lambs were killed and specimens of the bone examined histologically and radiographically. Shockwaves had no effect on the periosteal surface of mature cortical bone, but on the endosteal surface some new trabecular bone was seen. Healing of bone was delayed by the shockwave therapy. We conclude that there is currently little place for shockwave treatment in clinical orthopaedics.