5 It became known that there are electrical potentials in bone, including stress-generated potentials 5 and bioelectric or steady-state potentials. In 1953, Yasuda applied continuous current to a rabbit femur for three weeks and demonstrated new-bone formation in the vicinity of the cathode. There have been case reports of success using electrical stimulation as early as 1841, 4 but the use of this method of treatment did not progress until the 1950s. These modalities are less invasive to patients and the cost or complications related to harvesting an autograft are eliminated. This article focuses on the range of physical methods to stimulate bone healing including electrical stimulators, low-intensity pulsed ultrasound, and extracorporeal shock waves. A variety of biological, mechanical, and physical interventions have been developed to enhance fracture healing. The ability for fracture healing to be enhanced in the percentage of patients with impaired fracture healing would have a great economic impact, as well as enhance the physical and mental well-being of these patients. ![]() ![]() 3īone healing may be manipulated by external (biomechanical) and internal (biological) stimuli. Other risks for impaired fracture healing include contamination at the time of injury or operation, smoking, diabetes, and the skeletal location of the injury. The known reasons of delayed or impaired unions include problems with operative and nonoperative interventions, comprising inadequate mobilization of the fracture, distraction of fracture fragments by fixation devices or traction, repeated manipulations or excessive early motion of a fracture, excessive periosteal stripping, and damage to other soft tissues during operative exposure. The cause of nonunions and delayed healings of fractures is usually unknown. If these factors are inadequate or interrupted, healing is delayed or impaired, resulting in a nonunion of the bone. 1 Fracture healing is a complicated metabolic process and requires the interaction of many factors, including the recruitment of reparative cells and genes. ![]() However, out of the estimated 7.9 million fractures that occur annually in the United States, 5–10% of them develop nonunions and/or delayed unions, which are major sources of complications in the treatment of bone fractures. Fortunately, most fractures heal without any complications. The economic and health burden of fractures is large.
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