The effect of electrical bone stimulation on bone union in foot and ankle injuries: a scoping review

Abstract

Objective: This study aimed to evaluate the reported efficacy of electrical bone stimulation (EBS) in promoting union in foot and ankle fractures and arthrodesis by synthesizing the available literature. Methods: A literature review was conducted using PubMed/Medline, EMBASE, ScienceDirect, Web of Science, and CINAHL. Study type, patient demographics, interventions, and outcomes were extracted. The Methodological Index for Non-Randomized Studies assessment tool was used for methodological quality assessment and for evaluating outcomes regarding union rates. Results: Fourteen studies involving 1253 patients met inclusion criteria from a total of 668 screened articles. These studies involved 1253 patients treated with EBS for foot and ankle fracture and fusion surgeries. The majority of investigations reported increased success unionization and reduced time to union using EBS methods including direct current, capacitated coupling, pulsed electromagnetic field (PEMF), low-intensity pulsed ultrasound (LIPUS), and combined magnetic field. Conclusion: Although existing evidence suggests that EBS may enhance union rates, there is no consensus regarding the most effective stimulation modality due to limited comparative data. Emerging modalities such as PEMF and LIPUS demonstrate promising results; however, well-designed comparative studies are needed to clarify their relative efficacy and safety profiles.