Pulsed electromagnetic fields and low intensity pulsed ultrasound in bone tissue.

The use of physical stimuli to modulate osteogenetic response and favour fracture healing has been the subject of research for many years now. Currently, 78% of hospitals in the USA provide this treatment at 3 months from the trauma.In literature, the findings of many clinical studies agree in confirming that biophysical stimuli are able to lead to healing in 75-85% of patients with nonunions. Prospective, randomized and double-blind studies show that by employing biophysical stimuli the time needed for a fresh fracture to heal can be reduced "on average" by 25-38%. The treatment is suggested for healing of fresh fractures that are characterized as "risk fractures", fractures that can evolve in nonunions and that amount to 20% of all the fractures; this justifies the use of biophysical stimuli, with a favourable cost-benefit ratio.Current orthopaedics reviews the different modalities of biophysical treatment in search of solutions most adequate to the pathology, the characteristics of the fracture and those of the patient. It is up to the orthopaedist to assess whether the biomechanical conditions of stability of the fracture site are such as not to jeopardize the osteogenetic process. International clinical experience shows that success in biophysical therapy for bone regeneration depends on certain principal factors: suitable indication, efficacy of the device employed, method of stimulation and - of crucial importance - patient compliance. If these principles are kept in mind, the percentage of success of union, obtained with biophysical stimulation, exceeds 90%.