Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8242-8248
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8242
Low-intensity extracorporeal shock wave therapy for midshaft clavicular delayed union: A case report and review of literature
Lei Yue, Hao Chen, Tian-Hao Feng, Rui Wang, Hao-Lin Sun
Lei Yue, Tian-Hao Feng, Rui Wang, Hao-Lin Sun, Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China
Hao Chen, Department of Rehabilitation, Peking University First Hospital, Beijing 100034, China
Author contributions: Yue L, Chen H and Feng TH reviewed the literature and contributed to manuscript drafting; Chen H was the therapist of the patient; Yue L analyzed and interpreted the imaging findings; Sun HL and Wang R were the surgeons of the patient and responsible for the revision of the manuscript; all authors issued final approval for the version to be submitted.
Supported by Beijing Municipal Natural Science Foundation, No. 7212117.
Informed consent statement: Informed consent was obtained from the patient for the publication of this case report and any accompanying imaging.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hao-Lin Sun, MD, Associate Professor, Department of Orthopaedics, Peking University First Hospital, No. 8 Xishiku Ave, Beijing 100034, China.
Received: May 4, 2021
Peer-review started: May 4, 2021
First decision: June 24, 2021
Revised: July 5, 2021
Accepted: August 3, 2021
Article in press: August 3, 2021
Published online: September 26, 2021

One of the most common complications following surgery for midshaft clavicle fracture is nonunion/delayed union. Extracorporeal shock wave therapy (ESWT) is an alternative to promote new bone formation without surgical complications. To date, no literature has reported low-intensity ESWT (LI-ESWT) in delayed union of midshaft clavicle fracture.


We reported a 66-year-old Chinese amateur cyclist with clavicle delayed union treated with 10 sessions of LI-ESWT (radial, 0.057 mJ/mm2, 3 Hz, 3000 shocks). No anesthetics were applied, and no side effects occurred. At the 4 mo and 7 mo follow-ups, the patient achieved clinical and radiographical recovery, respectively.


In conclusion, our findings indicated that LI-ESWT could be a good option for treating midshaft clavicular delayed union.

Keywords: Shockwave therapy, Clavicle fracture, Delayed union, Extracorporeal shock wave therapy, Case report

Core Tip: Clavicle fracture is a common injury for cyclists, and surgical intervention could result in nonunion or delayed union. This is the first case report in the literature of low-intensity extracorporeal shock wave therapy treating midshaft clavicular delayed union. Our treatment protocol was unique in low-energy dosage, radial pattern, and multiple sessions. The clinical and radiographical outcomes were good, and the patient was able to return to sports, specifically amateur cycling, after a relatively short treatment period. The findings of this study could be particularly valuable for treating delayed union of clavicle fracture in athletes.