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Healing: Electrical Bone Stimulation (and Ultrasound)

I

I don't feel very expert about bone stimulators. There was a vogue for using electrical stimulators 20 years ago but they never found general acceptance and other more direct methods of dealing with nonunions seem to work most of the time.
Currently there seems to be some evidence being presented that stimulation with ultrasound is beneficial both for the prevention and treatment of nonunions. I have no direct experience of this although I am thinking of employing it and will be researching the issue at the upcoming AAOS meeting.
One of the people who follow this site is involved commercially in the sale of an ultrasound bone stimulator and he sent me a large database of papers on the subject. There are some contradictory studies in this collection which is troubling. I would say there is no consensus on the value of the treatment and it is not licenced in Canada as yet.
Bone Stimulation is proposed as treatment of a nonunion or to prevent a nonunion from occuring. Bone grafting and rigid fixation is one other way of treating nonunion as is the Ilizarov method, both of which are discussed briefly in the glossary. If it were proved that bone stimulation speeded up bone healing after fractures in humans and reduced the chances of nonunion the commercial prize would be enormous. Everyone who has a fracture might be benefitted by having an ultrasound device. Most of the studies that support this contention are financed by the manufacturers so there is scepticism about how objective the whole process is.
The big problem for the scientific evaluation of this subject is that fractures, patients and treatments are so variable that comparisons between the outcome of one treatment vs another is very difficult and requires huge numbers of patients.
Sorry not to be more definitive. It would be interesting to hear the experiences of borken-leggers who have has supplemental treatment with bone stimulators.
As for exactly how the stimulator achieve their effect, I don't know enough to have a worthwhile opinion.
Myles Clough MD 20 Jan 2002

Note added 22 Jan 2002

EBI has a patient information FAQ page about their electronic stimulation system - EBI Bone Healing System FAQ - Provided by the maunufacturer

Ultrasound Stimulation for Nonunion Fracture Healing: Decision Memorandum HCFA This has a useful description of fracture healing as well as a discussion of ultrasound. Concludes that Ultrasound stimulation should be covered for treatment of established nonunion.


From: Lynda

There seem to be quite a few questions recently about bone stimulators. I know that's what brought me to this site in the first place.

You haven't talked about them, what they do, how they do it, when they seem to be effective, how effective are they, other alternatives.

Could you fill in the gaps, please? No pun intended.


From: In the Know

As for the quality of the clinical data investigating ultrasound therapy, there are 2 gold standard randomized prospective double-blind multi-center studies (JBJS for Both) which support that ultrasound (Exogen) speeds fracture healing on average around 40% in the active group. It is commercially available in Canada and has now been for more than a year.

Ultrasound continues to be mistaken for Electrical stimulation (EBI)and unfortunately has had to overcome the stigma that electrical stimulation has had since the late 1970's. Peer review data is the hallmark of quality medicine and ultrasound has been met the rigors of peer review and continues to forge ahead with more and more clinical investigation around the globe. In fact, the concept of using sonic impulses to mimic the forces of wolff's law has been so well received that an international society (Micromechanical Tissue Repair Society )has been formed to conduct further research in this area. See link for membership.

Regards


From: David

I will be using an Exogen 2000 Sonic Accelerated Fracture Healing System, aka "Exogen Bone Stimulator" starting in two days I believe. Broke my ankle in three places (Trimalleolar break), Feb 24th 2002. Getting surgery tomorrow (March 8th), which will consist of two screws and a plate. Will be glad to post any information regarding my experience if anyone is interested. Just post a follow-up or email me.


From: Marilyn

I have had an EBI stimulator on for 5 weeks now. After one week an x-ray was taken and some bone growth was taking place. I really doubt if it was the EBI at that time. I also have been walking FWB the past month. I broke my fib/tib 11/12/2001. I have a circular fixator. I go to the doctor this Friday. Hopefully I will have good news concerning the EBI.


From: becca

I broke my ankle in three places roller skating in april 2002 I had surgery and a plate and screws put in I was having an extreme amount of pain from hardware so the surgeon took it out. Several weeks later he released me saying everything was great. My pain did not go away, i have popping and my ankle gives out on me. I went to different surgeon, who has gottem me an EBI. It needs to be used 10 hours a day. and has its own little charger. I have used it since November 2001 and I am still haveing problems. The xrays show some growth but he cant tell how much. I will probably have to get another MRI to see how well it is working. I still may have to have surgery where they take bone from the hip. I keep crossing my fingers because 2 surgeries is 2 to many for me another one would make me crazy. The bone stimulator does not hurt but still could not tell you how well it has done and it has been almost 3 months.
Hope this is helpfull information


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