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The Application of Pulsed Electromagnetic Fields (PEMFs) for Bone Fracture Repair: Past and Perspective Findings

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Abstract

Bone fractures are one of the most commonly occurring injuries of the musculoskeletal system. A highly complex physiological process, fracture healing has been studied extensively. Data from in vivo, in vitro and clinical studies, have shown pulsed electromagnetic fields (PEMFs) to be highly influential in the fracture repair process. Whilst the underlying mechanisms acting to either inhibit or advance the physiological processes are yet to be defined conclusively, several non-invasive point of use devices have been developed for the clinical treatment of fractures. With the complexity of the repair process, involving many components acting at different time steps, it has been a challenge to determine which PEMF exposure parameters (i.e., frequency of field, intensity of field and dose) will produce the most optimal repair. In addition, the development of an evidence-backed device comes with challenges of its own, with many elements (including process of exposure, construct materials and tissue densities) being highly influential to the field exposed. The objective of this review is to provide a broad recount of the applications of PEMFs in bone fracture repair and to then demonstrate what is further required for enhanced therapeutic outcomes.

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References

  1. Adie, S., I. Harris, J. Naylor, H. Rae, A. Dao, S. Yong, and V. Ying 2011. Pulsed electromagnetic field stimulation for acute tibial shaft fractures: a multicenter, double-blind, randomized trial. J. Bone Joint Surg. 93(17):1569–1576.

    Article  PubMed  Google Scholar 

  2. Ament, C. and E. Hofer 2000. A fuzzy logic model of fracture healing. J. Biomech. 33(8):961–968.

    Article  CAS  PubMed  Google Scholar 

  3. Andreykiv, A., F. Van Keulen, and P. Prendergast 2008. Simulation of fracture healing incorporating mechanoregulation of tissue differentiation and dispersal/proliferation of cells. Biomech. Model. Mechanobiol. 7(6):443–461.

    Article  CAS  PubMed  Google Scholar 

  4. Androjna, C., B. Fort, M. Zborowski, and R. J. Midura 2014. Pulsed electromagnetic field treatment enhances healing callus biomechanical properties in an animal model of osteoporotic fracture. Bioelectromagnetics, 35(6):396–405.

    Article  PubMed  Google Scholar 

  5. Assiotis, A., N. P. Sachinis, and B. E. Chalidis 2012. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature. J. Orthop. Surg. Res. 7(1):1.

    Article  Google Scholar 

  6. Atalay, Y., N. Gunes, M. D. Guner, V. Akpolat, M. S. Celik, and R. Guner 2015. Pentoxifylline and electromagnetic field improved bone fracture healing in rats. Drug Des. Dev. Ther. 9:5195–5201.

    Article  Google Scholar 

  7. Bailón-Plaza, A. and M. C. van der Meulen 2003. Beneficial effects of moderate, early loading and adverse effects of delayed or excessive loading on bone healing. J.Biomech. 36(8):1069–1077.

    Article  PubMed  Google Scholar 

  8. Bailón-Plaza, A. and M. C. Vander Meulen 2001. A mathematical framework to study the effects of growth factor influences on fracture healing. J.Theor. Biol. 212(2):191–209.

    Article  PubMed  Google Scholar 

  9. Barker, A., R. Dixon, W. Sharrard, and M. Sutcliffe 1984. Pulsed magnetic field therapy for tibial non-union: interim results of a double-blind trial. The Lancet, 323(8384):994–996.

    Article  Google Scholar 

  10. Barnaba, S., R. Papalia, L. Ruzzini, A. Sgambato, N. Maffulli, and V. Denaro 2013. Effect of pulsed electromagnetic fields on human osteoblast cultures. Physiother. Res. Int. 18(2):109–114.

    Article  PubMed  Google Scholar 

  11. Bassett, C. A. L. 1967. Biologic significance of piezoelectricity. Calcif. Tissue Res. 1(1):252–272.

    Article  Google Scholar 

  12. Bassett, C. A. L. 1982. Pulsing electromagnetic fields: a new method to modify cell behavior in calcified and noncalcified tissues. Calcif. Tissue Int. 34(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  13. Bassett, C. A. L. 1993. Beneficial effects of electromagnetic fields. J. Cell. Biochem. 51(4):387–393.

    Article  CAS  PubMed  Google Scholar 

  14. Bassett, C., S. Mitchell, and S. Gaston 1981. Treatment of ununited tibial diaphyseal fractures with pulsing electromagnetic fields. J. Bone Joint Surg. Am. 63(4):511–523.

    Article  CAS  PubMed  Google Scholar 

  15. Bassett, C., R. Pawluk, and A. Pilla 1974. Acceleration of fracture repair by electromagnetic fields. A surgically noninvasive method. Ann. N Y Acad. Sci. 238:242–262.

    Article  CAS  PubMed  Google Scholar 

  16. Beck, B. R., G. O. Matheson, G. Bergman, T. Norling, M. Fredericson, A. R. Hoffman, and R. Marcus 2008. Do capacitively coupled electric fields accelerate tibial stress fracture healing? A randomized controlled trial. Am. J. Sports Med. 36(3):545–553.

    Article  PubMed  Google Scholar 

  17. Behrens, S. B., M. E. Deren, and K. O. Monchik 2013. A review of bone growth stimulation for fracture treatment. Curr. Orthop. Pract. 24(1):84–91.

    Article  Google Scholar 

  18. Bernhardt, J. 1979. The direct influence of electromagnetic fields on nerve-and muscle cells of man within the frequency range of 1 hz to 30 mhz. Radiat. Environ. Biophys. 16(4):309–323.

    Article  CAS  PubMed  Google Scholar 

  19. Betti, E., S. Marchetti , R. Cadossi , C. Faldini, and A. Faldini. Effect of stimulation by low-frequency pulsed electromagnetic fields in subjects with fracture of the femoral neck. In: 1999. In: Electricity and Magnetism in Biology and Medicine, edited by F. Bersani. Springer: New York, 1999, pp. 853–855

    Chapter  Google Scholar 

  20. Biomet ®. Biomet ®orthopak ® non-invasive bone growth stimulator system.

  21. Brighton, C. T., W. Wang, R. Seldes, G. Zhang, and S. R. Pollack 2001. Signal transduction in electrically stimulated bone cells. J. Bone Joint Surg. Am. 83(10):1514–1523.

    Article  PubMed  Google Scholar 

  22. Byrne, D. P., D. Lacroix, and P. J. Prendergast 2011. Simulation of fracture healing in the tibia: Mechanoregulation of cell activity using a lattice modeling approach. J. Orthop. Res. 29(10):1496–1503.

    Article  PubMed  Google Scholar 

  23. Carlier, A., L. Geris, J. Lammens, and H. Van Oosterwyck 2015. Bringing computational models of bone regeneration to the clinic. Wiley Interdiscip. Rev. Syst. Biol. Med. 7(4):183–194.

    Article  PubMed  Google Scholar 

  24. Carter, D. R., G. S. Beaupre, N. J. J. Giori, J. A. J. A. Helms, and G. S. Beaupré 1998. Mechanobiology of skeletal regeneration. Clin. Orthop. Relat. Res. 355(355):S41–55.

    Article  Google Scholar 

  25. Ceccarelli, G., N. Bloise, M. Mantelli, G. Gastaldi, L. Fassina, M. G. Cusella De Angelis, D. Ferrari, M. Imbriani, and L. Visai 2013. AA comparative analysis of the in vitro effects of pulsed electromagnetic field treatment on osteogenic differentiation of two different mesenchymal cell lineages. BioRes. Open Access 2(4):283–294.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Chao, E. Y. S., N. Inoue, U. Ripamonti, and S. Fenwick 2003. Biophysical stimulation of bone fracture repair, regeneration and remodelling. Eur. Cells Mater. 6(1979):72–85.

    Article  Google Scholar 

  27. Checa, S. and P. J. Prendergast 2009. A mechanobiological model for tissue differentiation that includes angiogenesis: a lattice-based modeling approach. Ann. Biomed. Eng. 37(1):129–145.

    Article  PubMed  Google Scholar 

  28. Chen, C.-H., Y.-S. Lin, Y.-C. Fu, C.-K. Wang, S.-C. Wu, G.-J. Wang, R. Eswaramoorthy, Y.-H. Wang, C.-Z. Wang, Y.-H. Wang, and Others 2013. Electromagnetic fields enhance chondrogenesis of human adipose-derived stem cells in a chondrogenic microenvironment in vitro. J. Appl. Physiol. 114(5):647–655.

    Article  CAS  PubMed  Google Scholar 

  29. Chen, G., F. Niemeyer, T. Wehner, U. Simon, M. A. Schuetz, M. J. Pearcy, and L. E. Claes 2009. Simulation of the nutrient supply in fracture healing. J. Biomech. 42(15):2575–2583.

    Article  CAS  PubMed  Google Scholar 

  30. Claes, L., P. Augat, G. Suger, and H. J. Wilke 1997. Influence of size and stability of the osteotomy gap on the success of fracture healing. J. Orthop. Res. 15(4):577–584.

    Article  CAS  PubMed  Google Scholar 

  31. Claes, L. E. and C. A. Heigele 1999. Magnitudes of local stress and strain along bony surfaces predict the course and type of fracture healing. J. Biomech. 32(3):255–266.

    Article  CAS  PubMed  Google Scholar 

  32. Claes, L., S. Recknagel, and A. Ignatius 2012. Fracture healing under healthy and inflammatory conditions. Nat. Rev. Rheumatol. 8(3):133–143.

    Article  CAS  PubMed  Google Scholar 

  33. Clement, N., A. Duckworth, L. Biant, M. McQueen, et al. 2017. The changing epidemiology of fall-related fractures in adults. Injury, 48(4):819–824.

    Article  PubMed  Google Scholar 

  34. De Haas, W. G., A. Beupr, H. Cameron, and E. English 1986. The canadian experience with pulsed magnetic fields in the treatment of ununited tibial fractures. Clinical Rrthopaedics and Related Research, 208:55–58.

    Google Scholar 

  35. De Haas, W. G., M. A. Lazarovici, and D. M. Morrison 1979. The effect of low frequency magnetic fields on the healing of the osteotomized rabbit radius. Clin. Orthop. Relat. Res. (145):245–251.

    Google Scholar 

  36. Dimitriou, R., E. Tsiridis, and P. V. Giannoudis 2005. Current concepts of molecular aspects of bone healing. Injury, 36(12):1392–1404.

    Article  PubMed  Google Scholar 

  37. Einhorn, T. A. 2005. The science of fracture healing. J. Orthop.Trauma 19(10 Suppl):S4–S6.

    Article  PubMed  Google Scholar 

  38. Faldini, C., M. Cadossi, D. Luciani, E. Betti, E. Chiarello, and S. Giannini 2010. Electromagnetic bone growth stimulation in patients with femoral neck fractures treated with screws: prospective randomized double-blind study. Curr. Orthop. Pract. 21(3):282–287.

    Article  Google Scholar 

  39. Fu, Y.-C., C.-C. Lin, J.-K. Chang, C.-H. Chen, I.-C. Tai, G.-J. Wang, and M.-L. Ho 2014. A novel single pulsed electromagnetic field stimulates osteogenesis of bone marrow mesenchymal stem cells and bone repair. PloS ONE, 9(3):e91581.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Funk, R. H. W., T. Monsees, and N. Özkucur 2009. Electromagnetic effects - From cell biology to medicine. Progress in Histochemistry and Cytochemistry, 43(4):177–264.

    Article  PubMed  CAS  Google Scholar 

  41. Geris, L. 2014. Regenerative orthopaedics: In vitro, in vivo ... in silico. Int. Orthop. 38(9):1771–1778.

    Article  PubMed  Google Scholar 

  42. Geris, L., A. Gerisch, J. V. Sloten, R. Weiner, and H. V. Oosterwyck 2008. Angiogenesis in bone fracture healing: a bioregulatory model. J. Theor. Biol. 251(1):137–158.

    Article  CAS  PubMed  Google Scholar 

  43. Geris, L., Y. Guyot, J. Schrooten, and I. Papantoniou 2016. In silico regenerative medicine: how computational tools allow regulatory and financial challenges to be addressed in a volatile market. Interface Focus, 6(2):20150105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Geris, L., J. Vander Sloten, and H. Van Oosterwyck 2009. In silico biology of bone modelling and remodelling: regeneration. Philos. Trans. R. Soc. A 367(1895):2031–2053.

    Article  CAS  Google Scholar 

  45. Giannoudis, P., S. Psarakis, and G. Kontakis 2007. Can we accelerate fracture healing?: a critical analysis of the literature. Injury, 38(1):S81–S89.

    Article  PubMed  Google Scholar 

  46. Grace, K. L., W. J. Revell, and M. Brookes 1998. The effects of pulsed electromagnetism on fresh fracture healing: osteochondral repair in the rat femoral groove. Orthopaedics 21(3): 297–302.

    CAS  Google Scholar 

  47. Grodzinsky, A. 2011. Field, Forces and Flows in Biological Systems. London: Garland Science.

    Google Scholar 

  48. Gupta, A. K., K. P. Srivastava, S. Avasthi, et al. 2009. Pulsed electromagnetic stimulation in nonunion of tibial diaphyseal fractures. Indian J. Orthop. 43(2):156.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gómez-Benito, M. J., J. M. García-Aznar, J. H. Kuiper, and M. Doblaré 2005. Influence of fracture gap size on the pattern of long bone healing: a computational study. J. Theor. Biol. 235(1):105–119.

    Article  PubMed  Google Scholar 

  50. De Haas, W., J. Watson, and D. Morrison 1980. Non-invasive treatment of ununited fractures of the tibia using electrical stimulation. Bone Joint J. 62(4):465–470.

    Article  Google Scholar 

  51. Haddad, J. B., A. G. Obolensky, and P. Shinnick 2007. The biologic effects and the therapeutic mechanism of action of electric and electromagnetic field stimulation on bone and cartilage: new findings and a review of earlier work. J. Altern. Complement. Med. 13(5):485–490.

    Article  PubMed  Google Scholar 

  52. Hak, D. J., D. Fitzpatrick, J. A. Bishop, J. L. Marsh, S. Tilp, R. Schnettler, H. Simpson, and V. Alt 2014. Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. Injury, 45:S3–S7.

    Article  PubMed  Google Scholar 

  53. Heermeier, K., M. Spanner, J. Träger, R. Gradinger, P. G. Strauss, W. Kraus, and J. Schmidt 1998. Effects of extremely low frequency electromagnetic field (EMF) on collagen type I mRNA expression and extracellular matrix synthesis of human osteoblastic cells. Bioelectromagnetics, 19(4):222–231.

    Article  CAS  PubMed  Google Scholar 

  54. Hinsenkamp, M., F. Burny, M. Donkerwolcke, and E. Coussaert 1984. Electromagnetic stimulation of fresh fractures treated with hoffmann® external fixation. Orthopedics, 7(3):411–416.

    CAS  PubMed  Google Scholar 

  55. Ibiwoye, M. O., K. A. Powell, M. D. Grabiner, T. E. Patterson, Y. Sakai, M. Zborowski, A. Wolfman, and R. J. Midura 2004. Bone mass is preserved in a critical-sized osteotomy by low energy pulsed electromagnetic fields as quantitated by in vivo micro-computed tomography. J. Orthop. Res. 22(5):1086–1093.

    Article  PubMed  Google Scholar 

  56. Inoue, N., I. Ohnishi, D. Chen, L. W. Deitz, J. D. Schwardt, and E. Chao 2002. Effect of pulsed electromagnetic fields (PEMF) on late-phase osteotomy gap healing in a canine tibial model. J. Orthop. Res. 20(5):1106–1114.

    Article  PubMed  Google Scholar 

  57. Isaksson, H. 2012. Recent advances in mechanobiological modeling of bone regeneration. Mech. Res. Commun. 42:22–31.

    Article  Google Scholar 

  58. Isaksson, H., C. C. van Donkelaar, R. Huiskes, J. Yao, and K. Ito 2008. Determining the most important cellular characteristics for fracture healing using design of experiments methods. J. Theor. Biol. 255(1):26–39.

    Article  PubMed  Google Scholar 

  59. Isaksson, H., W. Wilson, C. C. van Donkelaar, R. Huiskes, and K. Ito 2006. Comparison of biophysical stimuli for mechano-regulation of tissue differentiation during fracture healing. J. Biomech. 39(8):1507–1516.

    Article  PubMed  Google Scholar 

  60. Jansen, J. H. W., O. P. van der Jagt, B. J. Punt, J. A. N. Verhaar, J. P. T. M. van Leeuwen, H. Weinans, and H. Jahr 2010. Stimulation of osteogenic differentiation in human osteoprogenitor cells by pulsed electromagnetic fields: an in vitro study. BMC Musculoskelet. Disord. 11(1):1.

    Article  CAS  Google Scholar 

  61. Kaivosoja, E., V. Sariola, Y. Chen, and Y. T. Konttinen 2015. The effect of pulsed electromagnetic fields and dehydroepiandrosterone on viability and osteo-induction of human mesenchymal stem cells. J. Tissue Eng. Regen. Med. 9(1):31–40.

    Article  CAS  PubMed  Google Scholar 

  62. Kalfas, I. H. 2001. Principles of bone healing. Neurosurg. Focus 10(4):E1.

    Article  CAS  PubMed  Google Scholar 

  63. Kirkpatrick, C., V. Krump-Konvalinkova, R. Unger, F. Bittinger, M. Otto, and K. Peters 2002. Tissue response and biomaterial integration: the efficacy of in vitro methods. Biomol. Eng. 19(2):211–217.

    Article  CAS  PubMed  Google Scholar 

  64. Lacroix, D., P. J. Prendergast, G. Li, and D. Marsh 2002. Biomechanical model to simulate tissue differentiation and bone regeneration: application to fracture healing. Med. Biol. Eng. Comput. 40(1):14–21.

    Article  CAS  PubMed  Google Scholar 

  65. Little, D. G., M. Ramachandran, and A. Schindeler 2007. The anabolic and catabolic responses in bone repair. Bone Joint J. 89(4):425–433.

    Article  CAS  Google Scholar 

  66. Luo, F., T. Hou, Z. Zhang, Z. Xie, X. Wu, and J. Xu 2012. Effects of pulsed electromagnetic field frequencies on the osteogenic differentiation of human mesenchymal stem cells. Orthopedics, 35(4):e526–e531.

    Article  PubMed  Google Scholar 

  67. Markov, M. S. 2007. Pulsed electromagnetic field therapy history, state of the art and future. The Environmentalist, 27(4):465–475.

    Article  Google Scholar 

  68. Mayer-Wagner, S., A. Passberger, B. Sievers, J. Aigner, B. Summer, T. S. Schiergens, V. Jansson, and P. E. Müller 2011. Effects of low frequency electromagnetic fields on the chondrogenic differentiation of human mesenchymal stem cells. Bioelectromagnetics, 32(4):283–290.

    Article  CAS  PubMed  Google Scholar 

  69. Maziarz, A., B. Kocan, M. Bester, S. Budzik, M. Cholewa, T. Ochiya, and A. Banas 2016. How electromagnetic fields can influence adult stem cells: positive and negative impacts. Stem Cell Res. Ther. 7(1):1.

    Article  CAS  Google Scholar 

  70. Midura, R. J., M. O. Ibiwoye, K. A. Powell, Y. Sakai, T. Doehring, M. D. Grabiner, T. E. Patterson, M. Zborowski, and A. Wolfman 2005. Pulsed electromagnetic field treatments enhance the healing of fibular osteotomies. J. Orthop. Res. 23(5):1035–1046.

    Article  PubMed  Google Scholar 

  71. Milde, F., M. Bergdorf, and P. Koumoutsakos 2008. A hybrid model for three-dimensional simulations of sprouting angiogenesis. Biophys. J. 95(7):3146–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Moore, A. and D. Burris 2014. An analytical model to predict interstitial lubrication of cartilage in migrating contact areas. J. Biomech. 47(1):148–153.

    Article  CAS  PubMed  Google Scholar 

  73. Nandra, R., L. Grover, and K. Porter 2016. Fracture non-union epidemiology and treatment. Trauma, 18(1):3–11.

    Article  Google Scholar 

  74. Nasr, S., S. Hunt, N. A. Duncan, et al. 2013. Effect of screw position on bone tissue differentiation within a fixed femoral fracture. J. Biomed. Sci. Eng. 6(12):71.

    Article  Google Scholar 

  75. Nunamaker, D. M. 1998. Experimental models of fracture repair. Clin. Orthop. Relat. Res. 355:S56–S65.

    Article  Google Scholar 

  76. Ongaro, A., A. Pellati, L. Bagheri, C. Fortini, S. Setti, and M. De Mattei 2014. Pulsed electromagnetic fields stimulate osteogenic differentiation in human bone marrow and adipose tissue derived mesenchymal stem cells. Bioelectromagnetics, 35(6):426–436.

    Article  CAS  PubMed  Google Scholar 

  77. Orthofix ®. Magnetic properties of materials.

  78. Orthofix ®. Products & tissue forms.

  79. Ossatec ®. Bone growth stimulator.

  80. Panagopoulos, D. J., A. Karabarbounis, and L. H. Margaritis 2002. Mechanism for action of electromagnetic fields on cells. Biochem. Biophys. Res. Commun. 298(1):95–102.

    Article  CAS  PubMed  Google Scholar 

  81. Pasco, J. A., S. E. Lane, S. L. Brennan-Olsen, K. L. Holloway, E. N. Timney, G. Bucki-Smith, A. G. Morse, A. G. Dobbins, L. J. Williams, N. K. Hyde, et al. 2015. The epidemiology of incident fracture from cradle to senescence. Calcif. Tissue Int. 97(6):568–576.

    Article  CAS  PubMed  Google Scholar 

  82. Peiffer, V., A. Gerisch, D. Vandepitte, H. Van Oosterwyck, and L. Geris 2011. A hybrid bioregulatory model of angiogenesis during bone fracture healing. Biomech. Model. Mechanobiol. 10(3):383–395.

    Article  PubMed  Google Scholar 

  83. Petecchia, L., F. Sbrana, R. Utzeri, M. Vercellino, C. Usai, L. Visai, M. Vassalli, and P. Gavazzo 2015. Electro-magnetic field promotes osteogenic differentiation of BM-hMSCs through a selective action on Ca2+-related mechanisms. Sci. Rep. doi: https://doi.org/10.1038/srep13856

    PubMed  PubMed Central  Google Scholar 

  84. Phillips, A. M. 2005. Overview of the fracture healing cascade. Injury, 36 (3):S5–7.

    Article  PubMed  Google Scholar 

  85. Pivonka, P. and C. R. Dunstan 2012. Role of mathematical modeling in bone fracture healing. BoneKEY Rep. doi: https://doi.org/10.1038/bonekey.2012.221

    PubMed  PubMed Central  Google Scholar 

  86. Pivonka, P. and S. V. Komarova 2010. Mathematical modeling in bone biology: from intracellular signaling to tissue mechanics. Bone, 47(2):181–189.

    Article  PubMed  Google Scholar 

  87. Pérez, M. A. and P. J. Prendergast 2007. Random-walk models of cell dispersal included in mechanobiological simulations of tissue differentiation. J. Biomech. 40(10):2244–2253.

    Article  PubMed  Google Scholar 

  88. Ross, C. L., M. Siriwardane, G. Almeida-Porada, C. D. Porada, P. Brink, G. J. Christ, and B. S. Harrison 2015. The effect of low-frequency electromagnetic field on human bone marrow stem/progenitor cell differentiation. Stem Cell Res. 15(1):96–108.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Ryaby, J. T. 1998. Clinical effects of electromagnetic and electric fields on fracture healing. Clin. Orthop. Relat. Res. 355:S205–S215.

    Article  Google Scholar 

  90. Schwartz, Z., B. Simon, M. Duran, G. Barabino, R. Chaudhri, and B. Boyan 2008. Pulsed electromagnetic fields enhance bmp-2 dependent osteoblastic differentiation of human mesenchymal stem cells. J. Orthop. Res. 26(9):1250–1255.

    Article  CAS  PubMed  Google Scholar 

  91. Scott, G. and J. King 1994. A prospective, double-blind trial of electrical capacitive coupling in the treatment of non-union of long bones. J. Bone Joint Surg. Am. 76(6):820–826.

    Article  CAS  PubMed  Google Scholar 

  92. Sharrard, W., M. Sutcliffe, M. Robson, and A. Maceachern 1982. The treatment of fibrous non-union of fractures by pulsing electromagnetic stimulation. Bone Joint J. 64(2):189–193.

    Article  CAS  Google Scholar 

  93. Shefelbine, S. J., P. Augat, L. Claes, and U. Simon 2005. Trabecular bone fracture healing simulation with finite element analysis and fuzzy logic. J. Biomech. 38(12):2440–2450.

    Article  PubMed  Google Scholar 

  94. Shi, H.-F., J. Xiong, Y.-X. Chen, J.-F. Wang, X.-S. Qiu, Y.-H. Wang, and Y. Qiu 2013. Early application of pulsed electromagnetic field in the treatment of postoperative delayed union of long-bone fractures: a prospective randomized controlled study. BMC Musculoskelet. Disord. 14(1):1.

    Article  Google Scholar 

  95. Simon, U., P. Augat, M. Utz, and L. Claes 2003. Simulation of tissue development and vascularisation in the callus healing process. Trans. Annu. Meet. Orthop. Res. Soc. 28:O299.

    Google Scholar 

  96. Simon, U., P. Augat, M. Utz, and L. Claes 2011. A numerical model of the fracture healing process that describes tissue development and revascularisation. Comput. Methods Biomech. Biomed. Eng. 14(1):79–93.

    Article  CAS  Google Scholar 

  97. Simonis, R., E. Parnell, P. Ray, and J. Peacock 2003. Electrical treatment of tibial non-union: a prospective, randomised, double-blind trial. Injury, 34(5):357–362.

    Article  CAS  PubMed  Google Scholar 

  98. Steinberg, F. U. 1980. The effects of immobilization on bone. In The Immobilized Patient, pp.  33–63. Springer.

  99. Sun, L.-Y., D.-K. Hsieh, P.-C. Lin, H.-T. Chiu, and T.-W. Chiou 2010. Pulsed electromagnetic fields accelerate proliferation and osteogenic gene expression in human bone marrow mesenchymal stem cells during osteogenic differentiation. Bioelectromagnetics, 31(3):209–219.

    CAS  PubMed  Google Scholar 

  100. Sun, L.-Y., D.-K. Hsieh, T.-C. Yu, H.-T. Chiu, S.-F. Lu, G.-H. Luo, T. K. Kuo, O. K. Lee, and T.-W. Chiou 2009. Effect of pulsed electromagnetic field on the proliferation and differentiation potential of human bone marrow mesenchymal stem cells. Bioelectromagnetics, 30(4):251–260.

    Article  CAS  PubMed  Google Scholar 

  101. Tsiridis, E., N. Upadhyay, and P. Giannoudis 2007. Molecular aspects of fracture healing: Which are the important molecules? Injury, 38(SUPPL. 1): S11–S25.

    Article  PubMed  Google Scholar 

  102. Vavva, M. G., K. N. Grivas, A. Carlier, D. Polyzos, L. Geris, H. Van Oosterwyck, and D. I. Fotiadis. A mechano-regulatory model for bone healing predictions under the influence of ultrasound. In Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. p. 921, 2015b

  103. Vavva, M. G., K. Grivas, D. Polyzos, D. I. Fotiadis, A. Carlier, L. Geris, and H. Van Oosterwyck. A mathematical model for bone healing predictions under the ultrasound effect. In Ultrasonic Characterization of Bone (ESUCB), 2015 6th European Symposium on IEEE, 2015a, pp. 1–4.

  104. Vecchia, P., R. Matthes, G. Ziegelberger, J. Lin, R. Saunders, and A. Swerdlow. Exposure to high frequency electromagnetic fields, biological effects and health consequences (100 khz-300 ghz). International Commission on Non-Ionizing Radiation Protection. 2009

  105. Vetter, A., F. Witt, O. Sander, G. Duda, and R. Weinkamer 2012. The spatio-temporal arrangement of different tissues during bone healing as a result of simple mechanobiological rules. Biomech. Model. Mechanobiol. 11(1–2):147–160.

    Article  CAS  PubMed  Google Scholar 

  106. Walther, M., F. Mayer, W. Kafka, and N. Schütze 2007. Effects of weak, low-frequency pulsed electromagnetic fields (bemer type) on gene expression of human mesenchymal stem cells and chondrocytes: an in vitro study. Electromagn. Biol. Med. 26(3):179–190.

    Article  CAS  PubMed  Google Scholar 

  107. Watts, J. J., J. Abimanyi-Ochom, and K. M. Sanders 2013. Osteoporosis costing all australians: a new burden of disease analysis-2012 to 2022. Melbourne: Osteoporosis Australia

    Google Scholar 

  108. Wehner, T., L. Claes, F. Niemeyer, D. Nolte, and U. Simon 2010. Influence of the fixation stability on the healing time a numerical study of a patient-specific fracture healing process. Clin. Biomech. 25(6):606–612.

    Article  Google Scholar 

  109. Wilson, C. J., M. A. Schütz, and D. R. Epari 2016. Computational simulation of bone fracture healing under inverse dynamisation. Biomech. Model. Mechanobiol. 16(1): 1–10.

    CAS  Google Scholar 

  110. Wraighte, P. J. and B. E. Scammell 2006. Principles of fracture healing. Surgery (Oxford), 24(6):198–207.

    Article  Google Scholar 

  111. Zamanian, A. and C. Hardiman 2005. Electromagnetic radiation and human health: a review of sources and effects. High Freq. Electron. 4(3):16–26.

    Google Scholar 

  112. Zhang, Y., D. Khan, J. Delling, and E. Tobiasch 2012. Mechanisms underlying the osteo- and adipo-differentiation of human mesenchymal stem cells. Sci. World J. 2012:793823.

    Google Scholar 

  113. Zhou, J., L. G. Ming, B. F. Ge, J. Q. Wang, R. Q. Zhu, Z. Wei, H. P. Ma, C. J. Xian, and K. M. Chen 2011. Effects of 50Hz sinusoidal electromagnetic fields of different intensities on proliferation, differentiation and mineralization potentials of rat osteoblasts. Bone, 49(4):753–761.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This research is supported by RMIT University, through the SECE Top Up Scholarship and the RMIT Enabling Capability Platform Capability Development Fund.

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Correspondence to C. Daish.

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Associate editor Michael R. Torry oversaw the review of this article.

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Daish, C., Blanchard, R., Fox, K. et al. The Application of Pulsed Electromagnetic Fields (PEMFs) for Bone Fracture Repair: Past and Perspective Findings. Ann Biomed Eng 46, 525–542 (2018). https://doi.org/10.1007/s10439-018-1982-1

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  • DOI: https://doi.org/10.1007/s10439-018-1982-1

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