Low-intensity Electromagnetic and Mechanical Modulation of Bone Growth and Repair: Are They Equivalent?

Signals from both electromagnetic fields (EMF) and ultrasound (US) have a clinically significant effect upon bone repair. Both modalities are now a common part of the orthopedist's armamentarium for the care of delayed union, nonunion, and fresh fractures. Dynamization or controlled weight bearing also enhances bone repair. Consideration of the dosimetry of both EMF and US modalities suggests a possible unifying mechanism for the bioeffects from EMF, US, and strain-generated potentials (SGP) signals based on the time-varying electric field, E(t), associated with each type of stimulus. The E(t) field is directly induced with EMF devices and indirectly induced via the streaming potentials associated with the mechanical movement of ionic fluids within bone caniculi or directly past cell surfaces from US and SGP signals. It is shown that both electrically and mechanically induced E(t) have common waveform characteristics at the treatment site and thus can deliver similar doses of electrical stimulation. It is proposed that the time-varying endogenous electric field, E(t), from a time-varying change in the mechanical environment of healing or remodeling bone, can act as a dose-dependent growth stimulus. Thus, the primary messenger affecting cellular activity is E(t), suggesting that bone repair or remodeling may be interchangeably modulated using mechanical (including US) or electromagnetic signals.