To The Editor:
I would like to congratulate Dr. Cacchio and colleagues on their excellent study "Extracorporeal Shock-Wave Therapy Compared with Surgery for Hypertrophic Long-Bone Nonunions" (2009;91:2589-97). A randomized trial of this nature is certainly a much-needed study that helps the practicing clinician determine the role of this nonoperative modality (extracorporeal shock-wave therapy) in the treatment of established long bone nonunion. I have two specific questions regarding their data:
First, in Table I, the data on the duration of nonunion in Group 3 (mean, 10.2 ± 6.1 months) would suggest that some patients were treated earlier than six months after their injury, whereas the Materials and Methods section states that nonunion was defined at a minimum of six months after treatment. This information is important and would have some influence on an orthopaedic surgeon's decision as to when this treatment is best initiated.
Second, the data in Table I and the information in the Materials and Methods section state that no humeral nonunions were included in the study, yet Figure 3 shows a humeral nonunion, and the "Adverse Effects" section discusses a complication following the treatment of a distal humeral nonunion. The applicability (or lack thereof) of extracorporeal shock-wave therapy to humeral nonunions would be of interest to practicing clinicians.