The clinical use of bone stimulators

Delay or failure of healing in long bone fracture is a common clinical problem confronting the orthopaedic surgeon, and can have significant impact on the quality of life for patients who have it. One treatment option for this problem is the use of electrical or ultrasonic bone stimulation. Electrical signals can be delivered with an implantable direct current stimulator, or noninvasively using inductive or capacitive coupling to induce currents in the tissues. Low-intensity ultrasound can speed the healing of fresh fractures. Although regarded with skepticism by many physicians, there is abundant evidence from clinical studies of the effectiveness of these treatments. In addition to dozens of retrospective reports, randomized, prospective, double-blind controlled trials have shown the efficacy of electrical stimulation for nonunion and ultrasound for speeding healing. Patients with unacceptable deformity, synovial pseudarthrosis, or large gaps are generally not good candidates for this treatment modality. This article is a review of the clinical literature regarding treatment of long bone nonunion with bone stimulators.