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Conclusion
Instrumented TSFs are a useful means of assessing the forces acting during
healing. Monitoring of these forces can help determine optimal removal.
Paper 322
Presenter: M Bhandari
Authors: I.S. Aleem, I. Aleem, N. Evaniew, J. Busse, M. Yaszemski, A. Agarwal, T.
Einhorn, M. Bhandari
Disclosure: Yes: MB has received honorariums from Smith & Nephew, Stryker,
Amgen, Zimmer, Moximed, Bioventus, Merck, Eli Lilly, Sanofi and research grants
from Smith & Nephew, DePuy, Eli Lily, Bioventus, Stryker, Zimmer, Amgen
Abstract title: Efficacy of Electrical Stimulators for Bone Healing: A
Meta-Analysis of Randomized Sham-Controlled Trials
Purpose: Electrical stimulators are commonly used to accelerate fracture healing,
resolve nonunions or delayed unions, and to promote spinal fusion. The efficacy of
electrical stimulator treatment, however, remains uncertain. We conducted a metaanalysis
of randomized sham-controlled trials to establish the effectiveness of electrical
stimulation for bone healing.
Methods: We searched MEDLINE, EMBASE, CINAHL and Cochrane Central
to identify all randomized sham-controlled trials evaluating electrical stimulators in
patients with acute fractures, non-union, delayed union, osteotomy healing or spinal
fusion, published up to February 2015. Our outcomes were radiographic nonunion,
patient-reported pain and self-reported function. Two reviewers independently
assessed eligibility and risk of bias, performed data extraction, and rated overall
confidence in the effect estimates according to the Grading of Recommendations
Assessment, Development and Evaluation (GRADE) approach.
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Results: Fifteen randomized trials met our inclusion criteria. Electrical stimulation
reduced the relative risk of radiographic nonunion or persistent nonunion by 35%
(95% CI 19% to 47%; 15 trials; 1247 patients; number needed to treat = 7; p <
0.01; moderate certainty). Electrical stimulation also showed a significant reduction
in patient-reported pain (Mean Difference (MD) on the 100-millimeter visual analogue
scale = -7.67; 95% CI -13.92 to -1.43; 4 trials; 195 patients; p = 0.02; moderate
certainty). Limited functional outcome data showed no difference with electrical
stimulation (MD -0.88; 95% CI -6.63 to 4.87; 2 trials; 316 patients; p = 0.76; low
certainty).
Conclusion: Patients treated with electrical stimulation as an adjunct for bone
healing have a reduced risk of radiographic nonunion or persistent nonunion and less
pain; functional outcome data are limited and requires increased focus in future trials.
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