Electrical Stimulation and Time to Radiographic Healing of Acute Fractures: A Systematic Review and Meta-Analysis

ObjectiveTo determine if electrical stimulation (ES) reduces days to radiographic union of acute fractures Data SourcesMEDLINE database search using the terms combinations of "electric stimulation AND bone healing", "electric stimulation AND fracture," "electric stimulation AND fracture healing," full articles, English language, without publication date restriction Study SelectionInclusion criteria were (1) randomized-controlled trials concerning electrical stimulation for the purpose of healing acute fractures with (2) outcomes on radiographic union at regular time intervals. Exclusion criteria were (1) studies involving skeletally immature patients or (2) ES for non-unions, spinal fusions, and osteotomies. Data ExtractionStudy quality was assessed with the Cochrane Collaboration tool for risk of bias assessment by 2 independent reviewers. Heterogeneity between studies was assessed with the {chi}2 and I2 tests. Data SynthesisThe mean days to radiographic union was calculated as a continuous variable with standard deviations. The meta-analysis was performed to compare the ES and non-ES groups across studies using Metafor (R) software (Bell Labs, Murray Hill, NJ, United States). ConclusionElectrical stimulation does not reduce time to radiographic union in acute fractures. However, an improvement in the healing time was noted in the semi-invasive method of ES in which the current was delivered directly within the fracture site. This finding provides evidence that innovative methods of ES delivery may demonstrate the promising results found in smaller animal studies. Level of EvidenceLevel I