Effect of Early Extracorporeal Shockwave Therapy on Postoperative Pain and Functional Recovery After Intramedullary Nailing: An Open-Label Randomized Controlled Trial

Background/Objectives: Intramedullary (IM) nailing for hip fractures can cause iatrogenic abductor muscle injury, leading to pain and functional impairment. This study evaluated whether early extracorporeal shockwave therapy (ESWT) safely accelerates recovery. Methods: In this open-label randomized controlled trial, 51 patients (≥50 years; intention-to-treat: ESWT n = 26; control n = 25) received either standard postoperative care (control) or standard care plus three ESWT sessions. The primary outcome was pain (Visual Analog Scale, VAS); the secondary outcome was hip function (modified Harris Hip Score, mHHS), assessed at 3, 6, and 12 months. Results: Linear mixed-effects modeling showed significantly faster pain reduction in the ESWT group (group × time β = 0.086 points/month; p = 0.027), corresponding to an additional 1.0-point VAS reduction over 12 months. Functional improvement (mHHS) did not reach statistical significance (group × time β = 0.485; p = 0.462). No ESWT-related adverse events were observed. Conclusions: Early postoperative ESWT is a safe adjunctive therapy that accelerates pain relief after IM nailing for hip fractures. Although functional improvements were not statistically significant, pain reduction may facilitate early mobilization and rehabilitation.