The Journal of Bone and Joint Surgery, Vol 63, Issue 1 2-13, Copyright © 1981 by Journal of Bone and Joint Surgery, Inc
A multicenter study of the treatment of non-union with constant direct current
CT Brighton, J Black, ZB Friedenberg, JL Esterhai, LJ Day and JF Connolly
A clinical study was initiated at the University of Pennsylvania in 1970 to
evaluate the use of constant direct current in treating acquired non-union.
In 1977 the study was expanded to include twelve participating
investigators throughout the United States. The results indicate that,
given proper electrical parameters and proper cast immobilization, a rate
of bone union comparable to that seen with bone-graft surgery was achieved.
Experience dictated that four cathodes, each delivering twenty microamperes
of constant direct current for twelve weeks, were required to heal a
non-union of a long bone. Of 178 non-union in 175 patients treated with
adequate electricity in the University of Pennsylvania series, 149 (83.7
per cent) achieved solid bone union. Patients with a history of
osteomyelitis had a healing rate of 74.4 per cent. The presence of
previously inserted metallic fixation devices did not affect the end-result
healing rate. Of eighty non-unions in seventy-nine patients treated with
electricity in the participating investigators' series, fifty-eight (72.5
per cent) achieved solid bone union. Review of the non-unions treated
unsuccessfully with constant direct current suggested that inadequate
electricity, the presence of synovial pseudarthrosis or infection, and
dislodgment of the electrodes are causes for failure with the procedure.
Complications of the electrical treatment were minor and there was no deep
infection resulting from this procedure in patients without previous
osteomyelitis. We concluded that the practicing orthopaedic surgeon
utilizing constant direct current to treat non-union should, by adhering to
proper fracture management and by following the biophysical principles
described herein, be able to achieve a rate of union comparable to that of
bone-graft surgery, with a lower associated risk.
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