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70 Executive Briefing Electrical Bone Stimulators: New Evidence Supports Treatment for Bone Healing By Anuja Vadya E lectrical bone stimulators are an evidence-based option to promote bone healing. "We live in an era where evidence-based practice is the dom- inant paradigm," says Mohit Bhandari, MD, MSc, PhD, FRSC, pro- fessor in the department of surgery and academic division head of orthopedic surgery at McMaster University in Hamilton, Canada. "In the 1990s evidence-based medicine (EBM) was defined as the conscientious use of clinical best evidence in the care of a patient. EBM is here to stay and we are using it to help healthcare practi- tioners drive better decision-making in healthcare." There are many treatment options for patients and identifying the right treatment for the right patient at the right time de- mand good evidence. Studies and evidence allow surgeons and patients to make more informed decisions and achieve better outcomes. "Better decision-making separates a good surgeon from a great surgeon and evidence driven clinical judgment is abso- lutely essential to ensure the highest standards of patient safety and care," he says. Orthopedic providers looking for minimally invasive treatment options for fracture patients have considered numerous bone healing agents, including biologics. Many options are often too early in their development or have deficient evidence for clinical practice. However, bone stimulators have mounting evidence and can be applied externally as non-invasive devices. They have been used in the treatment of nonunions for decades. "The mere fact that it has been around for decades suggests promise for bone stimulation," Dr. Bhandari says. "Other treat- ments, such as biologics, have come and gone, but a growing number of healthcare providers have been using bone stimula- tors because they have seen results consistent with evidence." Evidence for bone stimulation According to Dr. Bhandari, a bone stimulator is an externally ap- plied, non-invasive device intended to "stimulate healing of dam- aged tissue." Primary treatments include extracorporeal shock waves, electrical stimulation and low-intensity pulsed ultrasound. "We still think of extracorporeal shock waves therapy as being fairly preliminary, and although there are randomized trials that suggest there is benefit, there are not enough of them," said Dr. Bhandari. Dr. Bhandari said electrical bone stimulation, howev- er, has a larger body of supporting evidence. Electrical bone stimulation includes the following areas: • Capacitive Coupling, which involves the use of metal elec- trodes that are applied to the skin to deliver the current • Pulsed Electromagnetic Field devices, which use an exter- nally applied coil to deliver the current that can be pulsed on and off • Combined Magnetic Field devices, which use an external coil system with a combination of direct and alternating cur- rent to produce both static and alternating magnetic fields "The mere fact that it has been around for decades suggests promise for bone stimulation. Other treatments, such as biologics, have come and gone, but a growing number of healthcare providers have been using bone stimulators because they have seen results consistent with evidence." — Dr. Mohit Bhandari, MD, MSc, PhD, FRSC, Professor and Head of Orthopedic Surgery at McMaster University Sponsored by: