Pulsed Electromagnetic Field (PEMF) Stimulation for the Treatment of Fifth Metatarsal Fracture Nonunion

Background Healing success for fifth metatarsal fracture nonunions is challenging and hindered by risk factors for nonunion. Pulsed electromagnetic field stimulation (PEMF) promotes bone healing and can help overcome biological deficiencies in patients at risk. Objective The current study assessed the impact of PEMF treatment to promote successful bone healing in metatarsal nonunion. Methods A multi-center, retrospective study was conducted to evaluate PEMF treatment for fifth metatarsal fracture nonunion. Subjects undergoing treatment and eligible for treatment with PEMF (PhysioStim™ device) were enrolled. Subjects were followed for up to 12 months to determine bone healing status determined by radiographic assessment. Subjects were assessed for healing status and impact of risk factors for nonunion. Results Fifty-six (n=56) subjects were included in the analysis. Subjects were 89.3% female with a mean age of 59.7 years. Of the risk factors studied, 75.0% of subjects had at least 1 risk factor associated with compromised bone healing. PEMF treatment started shortly after the nonunion diagnosis, and the average time from nonunion diagnosis until successful healing was 154.7 days. Approximately 62.5% of subjects showed successful healing of their 5th metatarsal fracture by 4 months; 75.0% of subjects healed by 6 months; 91.1% of subjects healed by 12-months. The number of risk factors (up to 5 total per subject) was associated with longer heal times (p<0.02). Of the risk factors studied, only nicotine use was associated with longer healing times (p<0.03). Conclusion Metatarsal nonunion subjects treated with PEMF achieved favorable time to healing despite having risk factors for compromised healing.