TIBIAL NONUNION TREATED WITH DIRECT-CURRENT, CAPACITIVE COUPLING, OR BONE-GRAFT

Two hundred seventy-one tibial nonunions of average duration of 23.5 m onths (range, 9-69 months) were treated with direct current (167 patie nts), capacitive coupled electrical stimulation (56 patients), or bone graft surgery (48 patients), Logistic regression analysis was used to compare heal rates among the 3 treatment methods, to identify risk fa ctors adversely affecting the heal rate, and to predict the probabilit y of successful healing of a nonunion of any given risk profile treate d with each of the 3 forms of therapy, Seven risk factors were identif ied: duration of nonunion, prior bone graft surgery, prior electrical treatment, open fracture, osteomyelitis, comminuted or oblique fractur e, and atrophic nonunion, When no risk factors were present, there wer e no significant differences among the 3 treatment methods, As progres sively more risk factors were present, the predicted heal rates decrea sed significantly regardless of the treatment method, Some differences among the treatment groups did appear in the heal rates: bone graft s urgery yielded a worse heal rate when there was a previous bone graft failure, and capacitive coupling had a worse heal rate in the presence of an atrophic nonunion.