The electrical stimulation of bone healing: Some policy issues

Treatment of delayed and nonunion of fractures has economic, social, and psychological implications for individuals and society. This noninvasive technology is rather simple, inexpensive, and the electronics are reliable. Despite the promising and supposedly miraculous achievements of electrical stimulation of bone healing, orthopaedists refrain from employing it on a large scale for all who can potentially benefit. Long-term follow-up results on large groups are not yet available, thus fundamental uncertainties as to costs and benefits still exist. This commentary focuses on three basic problems with the technology that can explain its limited utilization: 1) is the new formed bone a "normal" bone; 2) do we really understand the process underlying this new bone formation; and 3) is there any immediate or delayed damage to bone marrow? If more and better data become available to resolve the above uncertainties, we may see the procedure evolving beyond selected populations and even applied to heal simple fractures.