Treatment of nonunited scaphoid fractures by pulsed electromagnetic field and cast

Thirty-five of 44 nonunited scaphoid fractures that were at least 6 months old healed in a mean time of 4.3 months during pulsed electromagnetic field (PEMF) treatment using external coils and a thumb spica cast. The mean time from the onset of the fracture to treatment was 40 months. No concurrent operation was performed. Follow-up time averaged 8.4 months. Eight of nine fractures with avascular necrosis healed. Five of eight fractures in the proximal third healed. Twelve (75%) of 16 patients treated in short-arm thumb spica casts and PEMF healed versus 22 (92%) of 24 patients treated initially in long-arm thumb spica casts and PEMF. We have found PEMF to be a reliable alternative method of treating nonunited scaphoid fractures. Because of the low risk, simplicity of use, and reliability, we recommend its consideration in the treatment of undisplaced, nonunited fractures without carpal instability less than 5 years after the injury. Treatment should initially begin with a long-arm cast.