Each year in the United States an estimated 300,000 fractures fail to heal and are established as nonunion fractures [1]. Slow healing and nonunion fractures prove to be difficult to treat, costly and have implications on a patient’s quality of life. Traditionally, treatment includes invasive procedures such as surgery, internal and external fixation and bone grafting [1]. Bone growth stimulators have been found to be a valuable noninvasive therapy for nonunion fractures when used properly. Clinical studies support bone growth stimulators for effective treatment in fracture healing [1]. There are different brands and technologies of bone growth stimulators available for commercial use, each with specific features that are beneficial to patient’s needs. Optimal healing of nonunion fractures can be maximized through the selection of a device tailored to the patient’s lifestyle and condition.
CMF bone growth stimulator
Combined Magnetic Fields (CMF)
CMF is a form of inductive electromagnetic technology that combines a sinusoidal waveform that emits a frequency of 76 Hz against a static electric field. [1, 2] According to DJO Global, CMF produces a signal that travels through tissue to target bone healing by stimulating osteoblast cells and Igf2 which is a protein integral for bone healing. DJO claims CMF also increases bone cells through stimulation of mitosis or cell division, which naturally occurs every 24 hours.
Brand: DJO
Indications: CMF is a suitable option for noninvasive treatment of fractures that have been diagnosed as nonunion following trauma.
Contraindications: Patients with Synovial Pseudoarthrosis should not be considered for this treatment. This treatment should not be used for vertebra or flat bones, including the skull, ribs, sternum, scapula and pelvic bones. The magnetic field from this device may disrupt certain types of pacemaker or implantable cardioverter defibrillator. This device should never be placed near a pacemaker or if any fixation devices and or implants contain magnetic material.
Use: Treatment is easy to administer; device is portable and battery powered. With the push of 1 button device delivers steady signal. Recommended treatment time is 30 minutes per day.
Product Highlights: Device has built in patient record keeping which increases compliance. Can be worn comfortably over casts or fixation devices.
Orthofix PEMF cervical stimulator
Low Level Pulsed Electromagnetic Field (PEMF)
PEMF utilizes a changing electromagnetic field to create electromagnetic induction, which produces an electrical signal in bone. This electrical signal, which is burst at a frequency of 15Hz, stimulates the bioelectrical properties of the bone. The bioelectrical nature of the tissue is what then drives the biochemical processes in bone growth once stimulated, and thus acts as a mimic of normal physiological responses in the tissue [1]. PEMF differs from CMF by using these pulsed bursts of power, while CMF generates a constant frequency of 76Hz [2].
Brand: Orthofix Physiostim
Indications: PEMF is a suitable option for noninvasive treatment of fractures that have been diagnosed as nonunion following trauma.
The width of the targeted treatment area or the nonunion has to be less than ½ of the width of the bone it is located on.
Contraindications: Patients with Synovial Pseudoarthrosis should not be considered for this treatment. This treatment should not be used for vertebra or flat bones, including the skull, ribs, sternum, scapula and pelvic bones.
Use: Physician should discuss individual instructions regarding recommended activity level and treatment dosage. Treatments should be 3 hours per day with total treatment between 90 and 180 days as customized for patient specific needs.
Even though treatment time is 3 hours a day, patient compliance is still high because device is lightweight and adjustable so it is easy and comfortable to receive treatment anytime and during any kind of activity.
Product Highlights: Designed to be worn over casts, or with internal/external fixation devices. Patient compliance monitoring software built in for daily tracking. Custom made models to fit different anatomical areas designed to deliver optimal treatment.
Exogen ultrasound bone stimulator
Low intensity pulsed ultrasound (LIPUS)
With LIPUS, an electrical signal is used to stimulate a material within the device to vibrate at a specific frequency. The vibrations create ultrasonic waves or what is known as ultrasound. This mechanical signal can travel through soft tissue easily and even penetrate into the bone. At a specific frequency the ultrasonic signal increases bone mineralization, as well as modulate fluid flow and fluid penetration into the tissue spaces. This in turn provides much need blood and nutrients to the site of fracture to stimulate healing [1].
Brand: Exogen
Indications: LIPUS is a suitable option for noninvasive treatment of fractures that have been diagnosed as nonunion following trauma.
Recommended for fresh tibia and radius fractures.
Contraindications: This treatment should not be used for vertebra or flat bones, including the skull, ribs, sternum, scapula and pelvic bones.
Use: Device counts down treatment and shuts itself off after the 20 minute dose for accurate timing. Recommended treatment time is 20 minutes a day or as prescribed by physician.
Product Highlights: Exogen device records time and date of each treatment, can be made available to physician for monitoring of patient usage.
Device verifies correct use of device and will alert patient if no coupling gel present.
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References
- Behrens SB, Deren ME, Monchik KO. A review of bone growth stimulation for fracture treatment. Curr Orthop Pract. 2013; 24(1):84-91.
- Rabjohn, Linnie V. DPM. Electrical Stimulation of Bone: The Evolving Technology. Clinical Podiatry, Podiatry Management. 2008; 167 -176.
- Smith and Nephew. Exogen 4000+ Ultrasound Bone Healing System. 2006. Accessed 10/26/2015. www.exogen.com
- DJO CMF Patient Instructions. 2010. Accessed 10/30/2015. www.djoglobal.com
- Orthofix Physio- Stim Osteogenesis Stimulator Patient Manual. Accessed 10/30/2015. www.web.orthofix.com