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Bone Growth Stimulation

A Critical Analysis Review

Haglin, Jack M. BS1; Jain, Sukrit BS1; Eltorai, Adam E.M. MS1; Daniels, Alan H. MD1

doi: 10.2106/JBJS.RVW.16.00117
Review Article with Critical Analysis Component
Supplementary Content

  • ➢ Bone growth stimulators are increasingly used in the treatment of delayed union and nonunion after fracture, ankle fusion, and spinal fusion.
  • ➢ Substantial basic science and animal studies and clinical evidence exist for the use of bone growth stimulation.
  • ➢ Current Level-I evidence supports the use of capacitive coupling and inductive coupling stimulation for adjunctive use in spinal fusion to increase the successful fusion rate.
  • ➢ Substantial Level-I evidence is lacking for the treatment of acute high-risk fractures or delayed union and nonunion after fractures with bone growth stimulation.
  • ➢ Weak Level-I evidence supports low-intensity pulsed ultrasonic (LIPUS) stimulation for the adjunctive treatment of fresh high-risk fractures and both inductive coupling and capacitive coupling stimulation for the adjunctive treatment of delayed union or nonunion after fractures.
  • ➢ The Level-I evidence of the recently published TRUST (Trial to Evaluate Ultrasound in the Treatment of Tibial Fractures) trial indicates that LIPUS does not improve functional recovery or accelerate radiographic healing after intramedullary nailing of acute tibial shaft fractures. That study questions the clinical efficacy of adjunctive LIPUS for acute long-bone fractures and disproves its use for adjunctive treatment in acute tibial shaft fractures treated with intramedullary nailing.

1Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island

Copyright © 2017 by The Journal of Bone and Joint Surgery, Incorporated
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