Transcutaneous Electrical Nerve Stimulation for Nonunited Fractures

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Abstract
Clinical observations were made to assess the value of standard transcutaneous electrical nerve stimulation apparatus for enhancement of osteogenesis. Pulse width and rate were adjusted to obtain maximum stimulation time. Electrode placements were selected dependent on the presence of plaster immobilization, accessibility of the fracture site, and anatomical limitations. In all cases, minimal current intensities were used because earlier studies stressed microamperage levels. Linear, crossed, and transverse electrode placement patterns were used. Standard equipment was used, including monophasic and biphasic units with single and dual channels. Three case reports were cited in which fractures had been nonunited for at least six months prior to study. The patients administered the stimulation daily at home, with rented units, for one month before reevaluation. Radiographic changes reported were fibrous bridging and early ossification activity. Interestingly, the patients reported decreases in pain even though electrode placements were not optimal for analgesic effects. This simple, safe, effective, and inexpensive technique for stimulating early osteogenesis with nonunited fractures is suggested as a routine procedure with all fractures.

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