Treatment of nonunited fractures with capacitively coupled electric field

Fracture healing undoubtedly depends on the orthopedic treatment applied: alignment, immobilization and contact between the stumps of the fracture constitute the biomechanical basis for any effective orthopedic treatment capable of ensuring fracture healing. However, the relevance of the biological environment and the need to maximize the endogenous osteogenetic activity are becoming evident. Presently, osteogenesis can be enhancement by means of growth factors or physical stimulation. The aim of this study was to evaluate the effects of capacitively coupled electric field (CCEF), a physical method to stimulate osteogenesis, in patients suffering from nonunited fractures. Thirty patients were included in the study. Inclusion criteria foresaw: no radiological evidence of callus formation, the fracture site had to be stable, bone stumps were aligned and, in the presence of bone loss, its extension could not exceed half the diameter of the treated bone. The presence of infection did not preclude recruitment. Standard radiographs were used to determine fracture healing. Out of 30 patients, 22 were men and 8 women. The sites of treatment were: 10 tibiae, 9 femura, 5 forearms, 2 humeri and 4 others. The average length of the stimulation was 10 weeks and the average daily time of CCEF use was 8 h. Among patients that met the inclusion criteria the success healing rate was 84%, in contrast, healing was not observed among the 5 patients who did not meet the inclusion criteria (p<0.05). Our findings show that electrical stimulation of endogenous bone repair with CCEF is an effective treatment when the inclusion criteria, mechanical stability, contact and alignment at the fracture site are maintained. The presence of infection did not negatively affect bone healing. The treatment is well accepted by patients and compliance is definitely high; this study shows that 8 hours of daily use is effective.