Between 1997 and 2003, a total of 62 patients were treated with ESWT at the researchers' hospital, including five athletes with chronic stress fractures that failed to heal with medical or surgical therapy.

The athletes were between 13 and 22 years of age and had fractures involving the tibia in two cases and the inferior pubic ramus, fifth metatarsal bone, and medial malleolus of the ankle in one case each. The sports activities included baseball in two patients and basketball, marathon, and soccer in one patient each.

On average, the patients' fracture symptoms began 1 year prior to undergoing ESWT, lead author Dr. Masanori Taki, from Zensyukai Hospital Gunma Sports Medicine Research Center in Japan, and colleagues note. Each of the patients underwent one session of ESWT, performed under spinal anesthesia in an operating room.

Successful bone union was achieved in all cases roughly 3 months after ESWT, according to the report in The American Journal of Sports Medicine for July. The subjects were able to return to their sports between 3 and 6 months after ESWT.

"We require additional basic and clinical studies to understand the effectiveness of ESWT and further studies to determine optimal energy density levels and impulse rates," Dr. Taki's group concludes. "Nevertheless, when appropriately used, ESWT can be a safe and effective treatment for stress fractures, especially in resistant cases."

Am J Sports Med 2007;35:1188-1192.

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