Electrical bone stimulation devices in foot and ankle surgery: Types of devices, scientific basis, and clinical indications for their use

Because of an accumulating body of literature demonstrating beneficial effects of electrical bone stimulation on long bone delayed unions and nonunions, an increasing number of orthopaedic surgeons have adopted this technology with some success. On the other hand, while there is evidence that is suggestive of electrostimulation being beneficial for increasing foot and ankle arthrodesis union rates, insufficient evidence exists to support the routine use of electrostimulation with foot and ankle arthrodesis. Furthermore, little peer reviewed scientific literature exists to justify its routine use for treatment of high-risk fresh fractures, such as tibial and metaphyseal- diaphyseal fifth metatarsal fractures of the foot. Therefore, further prospective randomized controlled studies are required to justify its use for this indication. Summary Highlights 1. Electrical bone stimulation may have a role in the treatment of long bone delayed unions and nonunions, such as the tibia. Implantable DC devices have not been shown to be superior to noninvasive CC or PEMF devices. 2. Electrical bone stimulation may be a useful adjunct in the treatment of foot and ankle arthrodesis; however, insufficient evidence exists to support the routine use of electrostimulation in primary arthrodesis. 3. Implantable DC devices have not been shown to be superior to noninvasive PEMF devices in primary arthrodesis. In contrast, limited evidence exists to support invasive DC devices over noninvasive PEMF devices for established nonunions, particularly when two or more risk factors exist. 4. Further prospective randomized controlled clinical trials are needed to justify the routine use of electrical bone stimulation for the primary treatment of certain high-risk fractures including tibial and metaphyseal-diaphyseal fifth metatarsal fractures. Copyright © 2006 by the American Orthopaedic Foot & Ankle Society, Inc.