A Review of Bone Growth Stimulation for Fracture Treatment

Steve B. Behrens; Matthew E. Deren; Keith O. Monchik


Curr Orthop Pract. 2013;24(1):84-91. 

In This Article

Direct Current

To our knowledge, no Level I evidence exists for the use of direct current (DC) in the treatment of fracture nonunions (Table 2), with the majority of published work being case series (Level IV). Based on the abundance of Level IV evidence, the use of direct current bone stimulation for treatment of fracture nonunion has a Grade C recommendation. In 1980, Paterson et al.[29] described the effective treatment of 84 long bone delayed unions and nonunions, using an implanted DC stimulator in a multicenter, retrospective case series.[29] Eighty-six percent of patients achieved fracture healing in the series, and the authors described the bone growth stimulator as particularly useful in cases refractory to bone grafting procedures and infections. However, they had no control group. Brighton et al.[54] later confirmed these findings, with a successful union rate of 72.5–83.7% in 258 nonunions treated with DC stimulators, mirroring outcomes of bone-graft surgery at the time of publication.

Most recently, Hughes and Anglin[55] reported a retrospective cohort of 111 patients with an implanted DC stimulator for nonunion and an 85% successful union rate. The authors reported significant complications if electrodes were implanted into deep soft tissue wounds or osteomyelitis.[55] Esterhai et al.[56] described difficulty in treating humeral nonunions with percutaneously implanted DC electrodes in 39 patients, with a 46% union rate. Heppenstall[57] reported an 85% success rate in a prospective case series of 40 tibial nonunions, with failures in patients with significant bone loss and undetected pseudarthrosis.[57] Bora et al.[58] published a 71% rate of union in 17 scaphoid nonunions treated with DC stimulation, and described less morbidity than the alternative iliac crest bone grafting of the time. Day[59] reported a case series of 16 nonunions treated by percutaneous DC electrodes that resulted in a 69% union rate.