Ct. Brighton et al., TIBIAL NONUNION TREATED WITH DIRECT-CURRENT, CAPACITIVE COUPLING, OR BONE-GRAFT, Clinical orthopaedics and related research, (321), 1995, pp. 223-234
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.