Electromagnetism for Fracture Non-Unions - Simon Richards 1/11/2001

1950 -Fukada first identified electrical properties of bone. Coined the word "piezoelectric"

All tissues subjected to mechanical strain show electrical potential.

Found to stimulate secretion of IGF II, TGFb mRNA, collagen, proteoglycans

3 different types of electrical field used.

1. Direct current stimulation with electrodes-invasive. Electrodes placed at fracture site. 20ma, 1V

Brighton JBJS 63A.2-13.1981

78% success in 258 nonunions

2. Electromagnetic stimulation-noninvasive. Pulsed electromagnetic fields via external coil. 10ma, 20mV

JBJS 63A.511-523 1981

87% success in 127 nonunions

3. Capacity coupling-noninvasive. Electrodes on skin, giving a broad uniform field to fracture site. 7ma, 5V

JBJS 67A.577-585.1985

77% success in 23 nonunions

Authors	Scott G, King JB
Title	A prospective, double blind trial of electrical capacitive coupling in the treatment of non-union of long bones.
Reference	JBJS. 76A. 820-6.1994
Summary	The wonderful Royal London. 21 Pts with confirmed non-union. Blinded into electrical group or placebo. 6/12 treatement. Electrical group 6/10 united. Placebo 0/11 united
Critique	Good trial set up. Stringent protocols. But small numbers. Different bones.

Authors	Mammi G I, Rocchi R
Title	The electrical stimulation of tibial osteotomies - A double blind study
Reference	CORRS. 288. 246 - 253. 1993
Summary	40 patients treated with valgus UTO for medial OA. 20 in control group. 20 in active group . 60 days for 8hrs a day. Xray at 60 days post op. Xrays marked 1-4 (1 no union, 4 full union) Control group 74% in groups 1 and 2, 26% in groups 3 and 4. Average score=2.1 Stimulated group 28% in group 1 and 2, 72% in group 3 and 4. Average score 3
Critique	Again, good PRCDBT. Not # treatment.

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