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Long-term pulsed electromagnetic field (PEMF) results in congenital pseudarthrosis

Summary

Ninety-one patients with congenital pseudarthrosis of the tibia have been treated with pulsed electromagnetic fields (PEMFs) since 1973 and all except 4 followed to puberty. Lesions were stratified by roentgenographic appearance. Type I and type II had gaps less than 5 mm in width. Type III were atrophic, spindled, and had gaps in excess of 5 mm. Overall success in type I and II lesions was 43 of 60 (72%). Of those 28 patients seen before operative repair had been attempted, 7 of 8 type I lesions healed (88%), whereas 16 of 20 type II lesions healed (80%) on PEMFs and immobilization alone. Only 19% (6 of 31) type III lesions united, only one of which did not require surgery. Sixteen of 91 limbs (18%) were ultimately amputated, most before treatment principles were fully defined in 1980. Fourteen of these 16 patients (88%) had type III lesions. Refracture occurred in 22 patients, most as the result of significant trauma, in the absence of external brace support. Twelve of the 19 refractures, retreated with PEMFs and casts, healed on this regime. Episodic use of PEMFs proved effective in controlling stress fractures in several patients until they reached puberty. PEMFs, which are associated with no known risk, appear to be an effective, conservative adjunct in the management of this therapeutically challenging, congenital lesions.

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References

  1. Boyd HB (1982) Pathology and natural history of congenital pseudarthrosis of the tibia. Clin Orthop 166:5–13.

    PubMed  Google Scholar 

  2. Campanacci M, Nicoll EA, Pagella P (1981) The differential diagnosis of congenital pseudarthrosis of the tibia. Int Orthop 4:283–288

    PubMed  CAS  Google Scholar 

  3. Hardinge K (1972) Congenital anterior bowing of the tibia: the significance of different types in relation to pseudarthrosis. Ann R Col Surg Engl 51:17–30

    CAS  Google Scholar 

  4. Morrissy RT (1982) Congenital pseudarthrosis of the tibia: factors that affect results. Clin Orthop 166:21–27

    PubMed  Google Scholar 

  5. Murray HH, Lovell WW (1982) Congenital pseudarthrosis of the tibia: a long-term follow-up study. Clin Orthop 166:14–20

    PubMed  Google Scholar 

  6. Nicoll EA (1969) Infantile pseudarthrosis of the tibia. Editorial and annotations. J Bone Joint Surg 51B:589–592

    Google Scholar 

  7. Sharrard WJ (1984) Treatment of congenital and infantile pseudarthrosis of the tibia with pulsing electromagnetic fields. Orthop Clin North Am 15:143–162

    PubMed  CAS  Google Scholar 

  8. Umber JS, Moss SW, Coleman SS (1982) Surgical treatment of congenital pseudarthrosis of the tibia. Clin Orthop 166:28–33

    PubMed  Google Scholar 

  9. Morrissy RT (1982) Editorial comment: congenital pseudarthrosis. Clin Orthop 166:1

    Google Scholar 

  10. Hagen KF, Buncke HJ (1982) Treatment of congenital pseudarthrosis of the tibia with free-vascularized bone graft. Clin Orthop 166:34–44

    Google Scholar 

  11. Pho RWH, Levack B, Satuk K, Patradul A (1985) Freevascularized fibular graft in the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg 67B:64–70

    Google Scholar 

  12. Bassett CAL, Pawluk RJ, Becker RO (1964) Effects of electric currents on bone formation in vivo. Nature (Lond) 204:652–654

    Article  CAS  Google Scholar 

  13. Brighton CT, Friedenberg ZB, Zensky LM, Pollis PR (1975) Direct current stimulation on nonunion and congenital pseudarthrosis. J Bone Joint Surg 57A:368–377

    Google Scholar 

  14. Lavine LS, Lustrin I, Shamos MH (1977) Treatment of congenital pseudarthrosis of the tibia with direct current. Clin Orthop 124:69–74

    PubMed  Google Scholar 

  15. Paterson DC, Simonis RB (1985) Electrical stimulation in the treatment of congenital pseudarthrosis of the tibia. J Bone Joint Surg 67B:454–462

    Google Scholar 

  16. Von Stazger G, Herbst E (1981) Surgical and electrical methods in the treatment of congenital and post-traumatic pseudarthroses of the tibia. Clin Orthop 161:82–104

    Google Scholar 

  17. Bassett CAL, Pawluk RJ, Pilla AA (1974) Augmentation of bone repair by inductively coupled electromagnetic fields. Science 184:575–577

    PubMed  Article  CAS  Google Scholar 

  18. Bassett CAL, Caulo N, Kort J (1981) Congenital “pseudarthroses” of the tibia: treatment with pulsing electromagnetic fields. Clin Orthop 154:136–149

    PubMed  Google Scholar 

  19. Kort JS, Schink MM, Mitchell SN, Bassett CAL (1982) Congenital pseudarthrosis of the tibia: treatment with pulsing electromagnetic fields. The international experience. Clin Orthop 165:124–137

    PubMed  Google Scholar 

  20. Bassett CAL (1989) Fundamental and practical aspects of therapeutic uses of pulsed electromagnetic fields (PEMFs). CRC Crit Rev Biomed Eng 17:451–529

    CAS  Google Scholar 

  21. Sutcliffe ML, Goldberg AAJ (1982) The treatment of congenital pseudarthrosis of the tibia with pulsing electromagnetic fields: a survey of 52 cases. Clin Orthop 166:45–57

    PubMed  Google Scholar 

  22. Rinsky LA, Halpern A, Schurman DB, Bassett CAL (1980) Electrical stimulation of experimentally produced avascular necrosis of the femoral head. JBJS Orthop Trans 4:238

    Google Scholar 

  23. Braun KA, Lemons JE (1982) Effects of electromagnetic fields on the recovery of circulation in mature rabbit femoral healds. Trans Orthop Res Soc 7:313

    Google Scholar 

  24. Yen-Patton GPA, Patton WF, Beer DM, Jacobson BS (1988) Endothelial cell response to pulsed electromagnetic fields: stimulation of growth rate and angiogenesis in vitro. J Cell Physiol 134:37–46

    PubMed  Article  CAS  Google Scholar 

  25. Bassett CAL, Ascani MS, Lewis SM (1989) Effects of pulsed electromagnetic fields (PEMFs) on Steinberg ratings of femoral head osteonecrosis. Clin Orthop 246:172–185

    PubMed  Google Scholar 

  26. Aaron RK, Lennox D, Bunce GE, Jolly G (1989) The conservative treatment of osteonecrosis of the femoral head. Clin Orthop 249:209–218

    PubMed  Google Scholar 

  27. Bassett CAL, Mitchell SN, Schink MM (1982) Treatment of therapeutically resistant non-unions with bone grafts and pulsing electromagnetic fields (PEMFs). J Bone Joint Surg 64A:1214–1220

    Google Scholar 

  28. Bassett CAL, Hess K (1984) Synergistic effects of pulsed electromagnetic fields (PEMFs) and fresh canine cancellous bone grafts. JBJS Orthop Trans 8:341

    Google Scholar 

  29. Kold SE, Hickman J, Melsen F (1987) Preliminary study of quantitative aspects and the effects of pulsed electromagnetic fields treatment on the incorporation of equine cancellous bone grafts. Equine Vet J 19:120–124

    PubMed  CAS  Google Scholar 

  30. Bassett LS, Tzitzikalakis G, Pawluk RJ, Bassett CAL (1979) Prevention of disuse osteoporosis in the rat by means of pulsing electromagnetic fields. In: Brighton CT, Black J, Pollack SR (ed) Electrical properties of bone and cartilage: experimental effects and clinical applications. Grune and Stratton. New York, pp 311–331

    Google Scholar 

  31. Cain CD, Adey WR, Luben RA (1987) Evidence that pulsed electromagnetic fields inhibit coupling of adenylate cyclase by parathyroid hormone in bone cells. J Bone Miner Res 2:437–441

    PubMed  CAS  Google Scholar 

  32. Cruess RL, Kan K, Bassett CAL (1983) The effect of pulsing electromagnetic fields upon bone metabolism in an experimental model of disuse osteoporosis. Clin Orthop 173:245–250

    PubMed  Google Scholar 

  33. Luben RA, Cain CD, Chen MC-Y, Rosen DM, Adey WR (1982) Effects of electromagnetic stimuli on bone and bone cells in vitro: inhibition of responses to parathyroid hormone by lowenergy low-frequency fields. Proc Natl Acad Sci USA 79:4180–4184

    PubMed  Article  CAS  Google Scholar 

  34. Ruben CT, McLeod KJ, Lanyon LE (1989) Prevention of osteoporosis by pulsed electromagnetic fields. J Bone Joint Surg 71A:411–417

    Google Scholar 

  35. Tabarah F, Hoffmeier M, Gilbert F Jr, Batkin S, Bassett CAL (1990) Bone density changes in osteoporosis-prone women exposed to pulsed electromagnetic fields (PEMFs). J Bone Miner Res 5:437–442

    Article  Google Scholar 

  36. Ito H, Bassett CAL (1983) Effect of weak, pulsing electromagnetic fields on neural regeneration in the rat. Clin Orthop 181:283–290

    PubMed  Google Scholar 

  37. Orgel MG, O'Brian WJ, Murray HM (1984) Pulsing electromagnetic field therapy on nerve regeneration: an experimental study in the cat. Plast Reconstr Surg 73:173–182

    PubMed  CAS  Article  Google Scholar 

  38. Borsalino G, Bagnacani M, Bettati E, Fornaciari F, Rocchi R, Uluhogian S, Ceccherelli G, Cadossi R, Traina GC (1988) Electrical stimulation of human femoral intertrochanteric osteotomies: a double-blind study. Clin Orthop 237:256–263

    PubMed  Google Scholar 

  39. Sharrard WJW (1990) A double-blind trial of pulsed electromagnetic fields for delayed union of tibial fractures. J Bone Joint Surg 72B:347–355

    Google Scholar 

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Bassett, C.A.L., Schink-Ascani, M. Long-term pulsed electromagnetic field (PEMF) results in congenital pseudarthrosis. Calcif Tissue Int 49, 216–220 (1991). https://doi.org/10.1007/BF02556121

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  • DOI: https://doi.org/10.1007/BF02556121

Key words

  • Congenital Pseudarthrosis
  • Pulsed electromagnetic fields