Evaluation der Effektivität der PEMF Therapie bei frischen distalen Radiusfrakturen

The aim of this study is to assess the effectiveness of PEMF therapy in recent fractures of the distal radius. Fracture of the distal radius is a frequent injury. It accounts for approximately 1/6 of all fractures treated in an accident and emergency unit. There is much evidence in literature that use of electromagnetic stimulation may activate and speed up fracture healing. To date, there is no evidence in the case of distal radius fractures. This pilot study was performed to clarify whether there are measurable differences in speed of healing in recent radius fractures after conservative treatment or after external fixation with Kirschner-wires with and without additional PEMF therapy. Between February 2000 and January 2001 15 patients were included in the study. Patients with a fracture of the distal radius were divided into a PEMF group and a placebo group by balanced randomisation. After immobilisation of the fracture in a plaster cast, patients in the PEMF group were treated with a functioning PEMF device while patients in the placebo group were given an unfunctional PEMF device. Only the manufacturer was informed about the functional efficiency of each PEMF device. The device was to be put into use for at least 6 hours every day. To control the patients´ compliance, the devices had been fitted with hour meters not visible to the patient. These were analysed after treatment ended. Out of 15 patients 3 were excluded from further participation in the study because of drop-out criteria. Patients received a diary in which, with the help of a visual chart, they recorded the extent of discomfort and impairment, the amount of prescribed medication actually taken, daily hours that the PEMF device was put into use and paraesthesias possibly resulting from this. The following results relate to 12 patients treated and followed-up in a traumatology unit from T1 (day of accident) to T7 (week 10). At each checkup a standardised, organ related physical examination as well as an x-ray control before and after reposition and after weeks 1, 4 and 6 were performed. Patients in the PEMF group showed considerably less swelling and better motility of the affected limb than patients in the placebo group. On palpation of the limb, no differences were noted in terms of discomfort and induration. Concerning discomfort experienced, the average intensity of pain is 0.8 to 2.7 points lower in the PEMF group compared to the placebo group. Furthermore, analysis of fracture types shows that the severity of fractures differs between the 2 study groups. Another point complicating comparism between the 2 groups is that 43% of patients in the PEMF group were treated with external fixation with Kirschner-wires, while this applied to 60% of patients in the placebo group. Concerning radiological differences in both study groups, results within each group were comparable at all times and within the normal range. However, both study groups were inhomogenous to the extent that comparism between the 2 groups is not possible. The extent of fracture healing by assessment of the cortical bridges was particularly difficult to estimate at checkup date T4 because of the plaster cast covering the x-ray. Here, large differences were noticeable between the various examiners. Uneven distribution of fracture types, additional treatment in some patients in form of external fixation with Kirschner-wires and imprecise assessment of the extent of fracture healing in x-rays have a large impact on results and the conclusions that can be drawn from them. Therefore, it is not possible to make a realistic statement about the effectiveness of the use of PEMF. For a consecutive study it is important that patients fractures are comparable to each other and that only patients with fractures treatable with conservative methods are included. Furthermore, it is necessary to elect a method which enables fracture healing to be assessed objectively and accurately.