We performed a meta-analysis of randomized sham-controlled trials to determine the effect of electrical stimulation on bone healing, focusing on patient-important outcomes. Prior systematic reviews of electrical stimulation have been limited by narrow scope, poor methodologic quality, and a focus on radiographic healing over patient-important outcomes 12, 13, 14, 15, 16, 17, 18, 19. Clinical evidence to support the use of electrical stimulators for bone healing has been inconclusive. Basic science research suggests that electrical stimulation enhances the process of bone healing by stimulating the calcium-calmodulin pathway secondary to the upregulation of bone morphogenetic proteins, transforming growth factor-β and other cytokines 3, 7, 8, 9, 10, 11. The socioeconomic burden associated with bone healing complications such as delayed union or nonunion is substantial and includes direct treatment costs as well as personal and societal costs, such as lost wages, decreased productivity and delays returning to work 2, 3, 4.Įlectrical stimulation is a popular adjunctive therapy used to promote bone healing across a range of indications 5, 6. Secondary procedures to promote bone healing may be invasive, expensive, and result in significant patient morbidity. Failure or delays in bone healing often require further intervention and may result in serious morbidity such as increased pain and functional limitations 1.

Patients treated with electrical stimulation as an adjunct for bone healing have less pain and are at reduced risk for radiographic nonunion functional outcome data are limited and requires increased focus in future trials.īone healing is a complex physiological process and is the end goal in the treatment of patients with fractures, surgical osteotomies and spinal fusion procedures. Moderate quality evidence from 15 trials found that stimulation reduced radiographic nonunion rates by 35% (95% CI 19% to 47% number needed to treat = 7 p < 0.01). Moderate quality evidence from 4 trials found that stimulation produced a significant improvement in pain (mean difference (MD) on 100-millimeter visual analogue scale = −7.7 mm 95% CI −13.92 to −1.43 p = 0.02). Fifteen trials met our inclusion criteria. Two reviewers assessed eligibility and risk of bias, performed data extraction, and rated the quality of the evidence. Outcomes were pain relief, functional improvement, and radiographic nonunion. We identified all trials randomizing patients to electrical or sham stimulation for bone healing. We conducted a meta-analysis of randomized sham-controlled trials to establish the efficacy of electrical stimulation for bone healing. Electrical stimulation is a common adjunct used to promote bone healing its efficacy, however, remains uncertain.

Orthofix bone stimulator