Early application of pulsed electromagnetic field in the treatment of postoperative delayed union of long-bone fractures: a prospective randomized controlled study

BMC Musculoskeletal Disorders

Yong Qiu¹  Yin-he Wang¹  Xu-sheng Qiu¹  Jun-fei Wang¹  Yi-xin Chen¹  Jin Xiong¹  Hong-fei Shi¹ 

[1] Department of Orthopaedics, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing, China

关键词: Long-bone fracture;    Fracture healing;    Delayed union;    Electromagnetic field;   

Others  :  1134155
DOI  :  10.1186/1471-2474-14-35

 received in 2012-04-10, accepted in 2013-01-17,  发布年份 2013

【 摘 要 】

Background

Pulsed electromagnetic field (PEMF) is reported to be an effective adjunct for the management of nonunion long-bone fractures. Most studies implement PEMF treatment after 6 months or longer of delayed union or nonunion following fracture treatment. Despite these variations in treatment, the early application of PEMF following a diagnosis of a postoperative delayed union has not been specifically analyzed. In this study, the outcomes of postoperative delayed union of long-bone fractures treated with an early application of PEMF were evaluated as compared with a sham-treated control group.

Methods

In this prospective, randomized controlled study, a total of 58 long-bone fracture patients, who presented with delayed union of between 16 weeks and 6 months, were randomly split into two groups and subjected to an early application of PEMF or sham treatment. Clinical and radiological assessments were performed to evaluate the healing status. Treatment efficacy was assessed at three month intervals.

Results

Patients in the PEMF group showed a higher rate of union than those in the control group after the first three months of treatment, but this difference failed to achieve statistical significance. At the end of the study, PEMF treatment conducted for an average of 4.8 months led to a success rate of 77.4%. This was significantly higher than the control, which had an average duration of 4.4 months and a success rate of 48.1%. The total time from operation to the end of the study was a mean of 9.6 months for patients in the PEMF group.

Conclusions

Fracture patients treated with an early application of PEMF achieved a significantly increased rate of union and an overall reduced suffering time compared with patients that receive PEMF after the 6 months or more of delayed union, as described by others.

【 授权许可】

   
2013 Shi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Tseng SS, Lee MA, Reddi AH: Nonunions and the potential of stem cells in fracture-healing. J Bone Joint Surg Am 2008, 90(Suppl 1):92-98.
• [2]Einhorn TA, Laurencin CT, Lyons K: An AAOS-NIH symposium. Fracture repair: challenges, opportunities, and directions for future research. J Bone Joint Surg Am 2008, 90(2):438-442.
• [3]Calori GM, Mazza E, Colombo M, Ripamonti C, Tagliabue L: Treatment of long bone non-unions with polytherapy: Indications and clinical results. Injury 2011, 42(6):587-590.
• [4]Chao EY, Inoue N: Biophysical stimulation of bone fracture repair, regeneration and remodelling. Eur Cell Mater 2003, 6:72-84. discussion 84–75
• [5]Shi HF, Cheung WH, Qin L, Leung AH, Leung KS: Low-magnitude high-frequency vibration treatment augments fracture healing in ovariectomy-induced osteoporotic bone. Bone 2010, 46(5):1299-1305.
• [6]Bassett CA, Pilla AA, Pawluk RJ: A non-operative salvage of surgically-resistant pseudarthroses and non-unions by pulsing electromagnetic fields, A preliminary report. Clin Orthop Relat Res 1977, 124:128-143.
• [7]Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M: Electrical stimulation for long-bone fracture-healing: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am 2008, 90(11):2322-2330.
• [8]Griffin XL, Costa ML, Parsons N, Smith N: Electromagnetic field stimulation for treating delayed union or non-union of long bone fractures in adults. Cochrane Database Syst Rev 2011, 4:CD008471.
• [9]Novicoff WM, Manaswi A, Hogan MV, Brubaker SM, Mihalko WM, Saleh KJ: Critical analysis of the evidence for current technologies in bone-healing and repair. J Bone Joint Surg Am 2008, 90(Suppl 1):85-91.
• [10]Griffin XL, Warner F, Costa M: The role of electromagnetic stimulation in the management of established non-union of long bone fractures: what is the evidence? Injury 2008, 39(4):419-429.
• [11]Barker AT, Dixon RA, Sharrard WJ, Sutcliffe ML: Pulsed magnetic field therapy for tibial non-union, Interim results of a double-blind trial. Lancet 1984, 1(8384):994-996.
• [12]Scott G, King JB: A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones. J Bone Joint Surg Am 1994, 76(6):820-826.
• [13]Simonis RB, Parnell EJ, Ray PS, Peacock JL: Electrical treatment of tibial non-union: a prospective, randomised, double-blind trial. Injury 2003, 34(5):357-362.
• [14]Punt BJ, den Hoed PT, Fontijne WPJ: Pulsed electromagnetic fields in the treatment of nonunion. Eur J Orthop Surg Traumatol 2008, 18(2):127-133.
• [15]Heckman JD, Ingram AJ, Loyd RD, Luck JV Jr, Mayer PW: Nonunion treatment with pulsed electromagnetic fields. Clin Orthop Relat Res 1981, 161:58-66.
• [16]de Haas WG, Beaupre A, Cameron H, English E: The Canadian experience with pulsed magnetic fields in the treatment of ununited tibial fractures. Clin Orthop Relat Res 1986, 208:55-58.
• [17]Meskens MW, Stuyck JA, Mulier JC: Treatment of delayed union and nonunion of the tibia by pulsed electromagnetic fields, A retrospective follow-up. Bull Hosp Jt Dis Orthop Inst 1988, 48(2):170-175.
• [18]Sharrard WJ: A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures. J Bone Joint Surg Br 1990, 72(3):347-355.
• [19]Marsell R, Einhorn TA: The biology of fracture healing. Injury 2011, 42(6):551-555.
• [20]Campbell WC, Canale ST, Beaty JH: Campbell's operative orthopaedics. 11th edition. Philadelphia, PA: Mosby/Elsevier; 2008.
• [21]Dijkman BG, Sprague S, Schemitsch EH, Bhandari M: When is a fracture healed? Radiographic and clinical criteria revisited. J Orthop Trauma 2010, 24(Suppl 1):S76-S80.
• [22]Zimmermann G, Moghaddam A: Trauma: Non-union: New trends. In European Instructional Lectures. Volume 10. 1st edition. Edited by Bentley G. Dordrecht Heidelberg London New York: Springer; 2010:15-19.
• [23]Rodriguez-Merchan EC, Forriol F: Nonunion: general principles and experimental data. Clin Orthop Relat Res 2004, 419:4-12.
• [24]Khan Y, Laurencin CT: Fracture repair with ultrasound: clinical and cell-based evaluation. J Bone Joint Surg Am 2008, 90(Suppl 1):138-144.
• [25]Seebach C, Henrich D, Tewksbury R, Wilhelm K, Marzi I: Number and proliferative capacity of human mesenchymal stem cells are modulated positively in multiple trauma patients and negatively in atrophic nonunions. Calcif Tissue Int 2007, 80(4):294-300.
• [26]Hofmann A, Ritz U, Hessmann MH, Schmid C, Tresch A, Rompe JD, Meurer A, Rommens PM: Cell viability, osteoblast differentiation, and gene expression are altered in human osteoblasts from hypertrophic fracture non-unions. Bone 2008, 42(5):894-906.
• [27]Bassett CA, Mitchell SN, Gaston SR: Treatment of ununited tibial diaphyseal fractures with pulsing electromagnetic fields. J Bone Joint Surg Am 1981, 63(4):511-523.
• [28]Colson DJ, Browett JP, Fiddian NJ, Watson B: Treatment of delayed- and non-union of fractures using pulsed electromagnetic fields. J Biomed Eng 1988, 10(4):301-304.
• [29]Freedman LS: Pulsating electromagnetic fields in the treatment of delayed and non-union of fractures: results from a district general hospital. Injury 1985, 16(5):315-317.
• [30]Adie S, Harris IA, Naylor JM, Rae H, Dao A, Yong S, Ying V: Pulsed electromagnetic field stimulation for acute tibial shaft fractures: a multicenter, double-blind, randomized trial. J Bone Joint Surg Am 2011, 93(17):1569-1576.
• [31]Hayda RA, Brighton CT, Esterhai JL Jr: Pathophysiology of delayed healing. Clin Orthop Relat Res 1998, 355 Suppl:S31-S40.
• [32]Marsh D: Concepts of fracture union, delayed union, and nonunion. Clin Orthop Relat Res 1998, 355 Suppl:S22-S30.