The use of electrical current in the treatment of nonunions

The use of electrostimulation in the treatment of nonunions in human beings is gaining in popularity. Increased understanding of the electrophysiology of fracture healing has lead to advances in the utilization of electric currents to stimulate nonunions to heal without resorting to major orthopedic surgery and its attendant risks. Most workers report success rates of 75 to 85 per cent, which are comparable to rates achieved by more routine orthopedic techniques. Brighton suggested that the risk/benefit ratio was lower for direct-current treatment of nonunion than that associated with conventional bone-graft surgery in human beings. Such information is not yet available for the veterinary surgeon. However, some authors have questioned the glowing reports of successful electric stimulation of clinical nonunions, citing poor design of clinical trials, erratic or inappropriate selection of patients, and empiricism in interpretation of results. Although the use of electrotherapy for treatment of nonunions appears promising, much more work is needed to define those patients best able to respond favorably to such techniques. Nonunions in dogs and cats are now only rarely treated with electric current. To date, no major clinical studies have been published concerning such techniques, although much of the basic research in this area was done on animals. It would appear that the totally implantable stimulators have the most potential for use in small animals because minimal cooperation is required of the patient and client. Furthermore, such devices cannot be easily damaged or dislodged. Whether electric stimulation of nonunions in dogs and cats will replace or supplant conventional orthopedic techniques remains to be seen.