PEMF Therapy and Pseudoarthrosis

What is Pseudoarthrosis?

When a broken bone fails to heal properly, it’s called a pseudoarthrosis.

It’s a word of Greek origin and means a false joint. Pseudoarthroses are also known as non-unions.

These bone fracture complications typically occur when the fracture hasn’t been properly immobilized, when it becomes infected or has a limited blood supply.

The diagnosis is made with the help of X-ray imaging, but CT and MRI may be ordered in cases that are unclear.

They can happen in any bone in the body. However, we usually see them in the bones of arms and legs.

Humerus, tibia and 5th metatarsal bones are some of the most common localizations.

 

Symptoms

Every bone fracture has a certain time period, in which we expect it to heal properly.

If original symptoms persist for a long time (6 months or longer), the person has most likely developed a case of pseudoarthrosis.

The most common symptoms include:

• Pain at the site of the fracture. Some non-unions can be painless, but most of them are characterized by a persistent pain that gets worse with the movement of the affected limb.
• Swelling and deformity in the area of the fracture. Sometimes, there’s even a visible gap in the place where a bone should be.
• Difficulty bearing weight
• Clicking or other sounds during movement

 

Risk Factors

In the case of pseudoarthrosis, a doctor usually orders some blood tests in order to determine why the bone isn’t healing properly.

With an infection at the fracture site or another underlying medical condition is usually to blame.

Some of those conditions are:

• Poor nutrition habits and Vitamin D deficiency
• Old age
• Nicotine and alcohol use
• Diabetes
• NSAIDs (ibuprofen, aspirin)
• Thyroid disease and hyperparathyroidism
• Inadequate immobilization at the fracture site
• Infection and bone loss around the fracture

 

 

Conventional Therapy

Generally speaking, pseudoarthrosis is treated either surgically on non-surgically.

Surgical treatment involves internal or external fixation and in rare cases, bone grafting.

Non-surgical methods, on the other hand, are much less invasive.

Their main principle is bone stimulation.

This is done either by using ultrasound or PEMF therapy.

They are applied directly over the fracture site and must be used daily in order to have the desired effect.

 

PEMF and Pseudoarthrosis

As we’ve learned, pseudoarthrosis occurs when the two bone fragments don’t heal properly.

This is usually due to the lack of blood vessels.

The new bone can’t form with the condition of compromised circulation.

As a result, there is a gap where the new bone should be.

Luckily, PEMF has been shown to increase the circulation and the formation of blood vessels.

This is one of the possible explanations and the ongoing research is based on further exploring this, and coming up with new possible explanations.

There are several studies that show the benefit of PEMF therapy on bone health.

When PEMF therapy was first approved several years ago, bone regeneration was one of its first approved uses.

While the exact mechanism is still controversial, one thing is clear: PEMF has the ability to regenerate the bone, prevent the fractures from happening and correct them, if they don’t heal properly.

 

PEMF Research

The Effect of PEMF on Metatarsal Pseudoarthrosis

This U.S> study was performed in 2016 by a joint collaboration of researchers from Ohio and New Jersey.

They were trying to determine how PEMF therapy affects the healing time in pseudoarthrosis of the 5th metatarsal bone (1).

Metatarsal bones are located in the foot, between the phalanges and the tarsal bones.

They don’t have individual names, but instead, they’re numbered from one to five.

Their analogue in the hand is the metacarpal bone.

Metatarsal non-unions are one of the most common locations of non-unions.

Two American orthopedic surgeons conducted this randomized double-blind study.

They speculated that PEMF definitely improves bone regeneration, but they were trying to quantify this effect.

The research protocol included adults between the ages of 18 and 75, whose metatarsal non-union wasn’t healing after a minimum of three months.

In the end, only eight patients were included in the study.

The surgeons performed open biopsies and then analyzed the tissue for messenger ribonucleic acid (mRNA) using the PCR method.

The study participants were then randomized and divided into two groups.

One group received a real PEMF treatment, while the other received placebo stimulation.

After three weeks, they underwent another biopsy and internal fixation at the fracture site.

They were followed for two to four weeks and the X-rays were taken and graded.

The results are promising. The group which was treated with real PEMF had an average time of the union completion of 8.9 weeks.

The placebo group took longer: an average of 14.7 weeks, until their pseudoarthrosis was resolved.

The measurements of the placental growth factor (PIGF) also show a significant difference.

The PEMF group showed an increase in PIGF production.

The scientists noticed an increase in other factors, such as bone morphogenetic protein (BMP), subtypes BMP-5 and BMP-7, and a brain derived neurotrophic factor (BDNF).

The placebo control group didn’t display a statistically significant increase of these factors.

The researchers completed their findings by concluding that the use of PEMF therapy for 5th metatarsal fracture pseudoarthrosis leads to significantly shorter healing time.

An increase of PIGF and other factors is a probable mechanism of action, but further research is needed.

 

The Effect of PEMF on Congenital Pseudoarthrosis

This retrospective study conducted by Kort JS and Schink MM was published in 1982 (2).

It describes cases of congenital pseudoarthrosis of the tibia, a non-union of one of the leg bones that was present from birth.

The researchers reported on 92 patients from Europe and the U.S. who were treated with PEMF therapy.

They excluded 10 patients (11%) who showed refractory healing.

Out of the remaining 82 patients, 48 patients (59%) exhibited complete healing of their non-unions, while 34 (41%) didn’t heal at all.

Another result is that surgery in combination with PEMF didn’t improve the treatment outcome.

The poor prognosis factors were a large gap between the bones, spindled ends of the bones, and mobile lesions.

On the other hand, patients with a gap smaller than 5 mm and those with fracture lines that were transverse or cystic, had a better overall prognosis.

The research suggests the combination of orthopedic treatment with proper immobilization, in combination with PEMF therapy, to be a key to success.

At the end of the research paper, the scientists conclude that even though this condition  is still a major challenge for orthopedic surgeons, the inclusion of PEMF therapy displays important benefits for dealing with this destructive condition.

 

The Positive Effect of PEMF on Bone Cells

This Italian study dealt with the effects of PEMF on human osteoblasts (3).

Oateoblasts are simple cells that are in charge of bone synthesis.

They can only make bone in a group of connected cells, since individual osteoblasts aren’t capable of bone formation.

Scientists Barnaba S, Papalia R, and Ruzzini L speculate that PEMF has the ability to positively affect the bone metabolism.

They also found that PEMF can be effective in the treatment of both congenital and fracture pseudoarthrosis.

However, since the exact mechanism in charge of this phenomenon is unclear, they  attempted to determine it.

The researchers were able to isolate the primary osteoblasts from a human femur.

They then divided the specimens into two groups.

One group of cell cultures was treated with PEMF, while the other was exposed to placebo treatment.

After three, seven and ten days, these cells  were examined for their growth and alkaline-phosphatase (AP) activity.

The difference in cell numbers between the two groups was evident at each observation.

The AP activity in the PEMF group also showed a larger increase, compared to the placebo group.

The Italian researchers concluded that the PEMF stimulation of human bone cells has the ability to speed up cellular proliferation.

Therefore, PEMF therapy should be used in the therapy of bone defects, as a means of prevention, but also as a therapeutic agent.

 

The Effect of PEMF on Osteoporosis

Osteoporosis is a disease that gradually weakens bones, making them prone to fractures.

This 2001 Italian study, conducted at the University of Siena, determined the effects of PEMF on bone remodeling (4).

The researchers, Giordano N, Geraci S, Battisti E, and others, examined the effect of PEMF on bone turnover markers and the mineral density of bones.

The study included women with postmenopausal osteoporosis.

The research used a placebo-controlled and single-blind approach and included 40 patients.

Similar to previous research. they were divided into two groups.

One group received PEMF treatment of 100 Hz for 60 minutes a day, and the other was exposed to a placebo.

The research lasted for 90 days.

The measured outcome were the bone mineral density and the markers of bone metabolism.

They were determined before the study, in the end, and after a one-month follow-up.

The results showed no significant difference between the two groups in their bone mineral density.

However, the group treated with real PEMF showed an increase in bone metabolism markers (osteocalcin and procollagen type 1).

The findings suggest that PEMF is able to stimulate the formation of the new bone tissue.

The exact mechanism isn’t completely explained, but the scientists speculate that the stimulation of the activity of osteoblasts could be responsible.

 

The Effect of PEMF on Circulation

A U.S. research team conducted this 2004 experiment at the Wake Forest University School of Medicine in North Carolina (5).

The goal of the study was to examine whether PEMF had an effect on microcirculation.

As the researchers explained, PEMF is known for speeding up the healing of different tissues.

However, the exact mechanism remains a mystery.

The increase of arterial diameter may be one of the possible mechanisms responsible for this process.

They conducted their experiments on the cremaster muscles of rats.

The study was done on rats that were separated into two groups.

The first received PEMF, while the other received sham stimulation.

The sessions lasted anywhere from 2 to 60 minutes.

The researchers then measured the diameters of the blood vessels before and after the exposure.

They used intravital microscopy.

The study results showed that PEMF stimulation caused considerable vasodilatation of the cremasteric arterioles of twenty-four rats.

The dilation after two minutes of stimulation was 9% and after sixty minutes the diameter growth was 8.7%.

None of the rats that received the placebo demonstrated a significant increase in this diameter.

PEMF stimulation did not lead to changes in the arterial pressure, heart rate or any changes.

At the end of the research paper, the scientists concluded that these findings support the idea that PEMF causes significant arteriolar vasodilatation.

The study was originally performed in order to determine exactly how PEMF stimulates and speeds up the healing of fractures, and whether this is achieved by vasodilatation and improvements in blood circulation.

This hypothesis has definitely been confirmed.

A large portion of pseudoarthroses occur due to a limited blood supply.

This study has shown that PEMF therapy can be a reliable therapeutic approach in dealing with this condition.

 

Conclusion

Pseudoarthrosis, also known as non-union, is a condition that occurs when two bone fragments fail to heal properly after a fracture.

It can cause a great deal of suffering to the affected person, since it involves constant pain, deformities and difficulty bearing weight. The most common cause is poor circulation.

After all the science-based evidence from the previous chapter, it is clear that PEMF is an effective tool to consider in battling this condition.

PEMF treatment is widely known for its ability to improve the circulation at the site of application.

PEMF can also regenerate the bone tissue, prevent the fractures and correct them if they don’t heal properly.

The FDA has approved PEMF for the treatment of bone healing, so it may be used as the only means of therapy, or in combination with other methods.

Most importantly, it is completely non-invasive, has no side effects and it can even be used in long-term prevention.