title: Efficacy of Electrical Stimulators for Bone Healing: A Meta-Analysis of Randomized Sham-Controlled Trials.
abstract: Electrical stimulation is a common adjunct used to promote bone healing; its efficacy, however, remains uncertain. We conducted a meta-analysis of randomized sham-controlled trials to establish the efficacy of electrical stimulation for bone healing. We identified all trials randomizing patients to electrical or sham stimulation for bone healing. Outcomes were pain relief, functional improvement, and radiographic nonunion. Two reviewers assessed eligibility and risk of bias, performed data extraction, and rated the quality of the evidence. Fifteen trials met our inclusion criteria. Moderate quality evidence from 4 trials found that stimulation produced a significant improvement in pain (mean difference (MD) on 100-millimeter visual analogue scale = -7.7 mm; 95% CI -13.92 to -1.43; p = 0.02). Two trials found no difference in functional outcome (MD = -0.88; 95% CI -6.63 to 4.87; p = 0.76). Moderate quality evidence from 15 trials found that stimulation reduced radiographic nonunion rates by 35% (95% CI 19% to 47%; number needed to treat = 7; p < 0.01). Patients treated with electrical stimulation as an adjunct for bone healing have less pain and are at reduced risk for radiographic nonunion; functional outcome data are limited and requires increased focus in future trials.
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ilyas S
authors.initials: IS
authors.lastname: Aleem
authors.affiliation: Thalmic Labs, Kitchener, ON, Canada.
authors.forename: Idris
authors.initials: I
authors.lastname: Aleem
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Nathan
authors.initials: N
authors.lastname: Evaniew
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.|The Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada.|Department of Anesthesia, McMaster University, Hamilton, ON, Canada.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.affiliation: Department of Orthopaedics, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Yaszemski
authors.affiliation: University of Toronto Faculty of Medicine, Toronto, ON, Canada.
authors.forename: Arnav
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Einhorn
authors.affiliation: Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, ON, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
mesh_terms: D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D017102:Fracture Healing; D050723:Fractures, Bone / Q000628:therapy*; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic