PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

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Residency Education / Trauma & Sports Medicine

Bone Stimulation
Harold Schoenhaus, DPM

Harold Schoenhaus, DPM will discuss the use of bone stimulators in patients at risk for poor bone healing.
Dr Schoenhaus will review the different types of bone stimulators available and focus on advantages and
disadvantages of each.

CME (Credits: 1)

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PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

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Start your Pre-Test to begin the CME progress for credits.

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PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

Method of Participation

Complete the 4 steps to earn your CE/CME credit:

1. Complete the Pre-Test

2. View the Lecture

3. Complete the Quiz (Min. 70% Passing Score)

4. Complete the program Survey

Goals and Objectives

Complete the 4 steps to earn your CE/CME credit:

1. Understand indications
Complete the Pre-Test for bone stimulation

2. Understand different types of bone stimulation

View the Lecture

3. Understand contra-indications
Complete the of boneScore)
Quiz (Min. 70% Passing stimulator use

4. Understand concepts
Complete the programofSurvey
bone healing

Accreditation and Designation of Credits

1. Understand indications for bone stimulation

CME (Credits: 1) different types of bone stimulation

2. Understand
This lecture has been
3. Understand approved for of
contra-indications thebone
PRESENT Podiatric
stimulator use Education Online curriculum by the Council of
Teaching Hospitals Residency Education Review Committee.
4. Understand concepts of bone healing
Release Date: 01/01/2016 Expiration Date: 12/31/2018

Author

(Credits: 1)

CME
This lecture has been approved for the PRESENT Podiatric Education Online curriculum by the Council of
Teaching Hospitals Residency Education Review Committee.
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01/01/2016 12/31/2018
Release Date: Expiration Date:
PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

Harold Schoenhaus, DPM

Surgical Editor for PRESENT e-Learning
Penn-Presbyterian Medical Center
Philadelphia, PA

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PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

biomedical device manufacturers, or other corporations whose products or services are related to the subject
matter of the presentation topic. The intent of this policy is not to prevent a speaker with a potential conflict of
interest from making a presentation. It is merely intended that any potential conflict should be identified openly
so that the listeners may form their own judgments about the presentation with the full disclosure of the facts.

---
Harold Schoenhaus has nothing to disclose.

Lecture Transcript

biomedical
Bob: Okay. device
For ourmanufacturers,
next lecture, it’soraother corporations
pleasure to welcome whose products
somebody or services
well-known to are related
us who to the subject
happens to be the
matter of the presentation topic. The intent of this policy is not to prevent a speaker with a potential
Chair of Superbones Superwounds, Dr. Harold Schoenhaus. A friend and a long time colleague who hales from conflict of
interest from making a presentation. It is merely intended that any potential conflict should be identified openly
both Philadelphia and West Palm Beach, I guess, down in Florida. Dr. Schoenhaus has been a teacher to many,
so
manythatpeople
the listeners may form
in this room and their own judgments
a colleague about the
to many others. Hepresentation
has a wealthwith the full disclosure
of experience. He has of the facts.a
dedicated
lot
--- of his life to education and works very, very hard with the PRESENT team to bring the meetings and improve
the quality of the meetings to you to
has nothing all.disclose.
With that said, Dr. Schoenhaus is going to be talking about bone
Harold Schoenhaus
stimulation for nonunions and difficult fracture. Let’s welcome Dr. Harold Schoenhaus.

[Applause]

Harold Schoenhaus: Thank you, Bob. I do want to state that over the years with PRESENT, we have certainly
Bob: Okay.to
attempted For our next
educate lecture,
and it’sprofession
lead the a pleasure through
to welcome somebody well-known
the educational to us who happens
forum and environment, to be
providing thethe
Chair of Superbones Superwounds, Dr. Harold Schoenhaus. A friend and a long time colleague who hales from
state of the art of what’s being done today, what’s available, and what’s in the future. It can’t be done effectively
both Philadelphia
without co-chairs of and West Palm
meetings suchBeach,
as BobI guess, down
Frykberg who in is
Florida.
a dearDr. Schoenhaus
friend has been
of mine, great a teacher
educator, to many,
and the
many
PRESENTpeople in this
team. room and
Obviously, a colleague
seeing to many
the amount others.here
of people He has
on aaFriday,
wealthI’m
of experience. He has
pleased. I can’t dedicated
tell you just howa
lot of hisI life
pleased am.toI education andyour
thank you for works very,
time, thevery hard of
amount with theyou
time PRESENT
spend inteam to bring thewhich
the workshops meetings
givesand
youimprove
an
the quality oftothe
opportunity meetings
spend to you
time with theall. With thatlearn
sponsors, said,new
Dr. Schoenhaus
products, getisa going
feelingtofor
beittalking about
and have thebone
opportunity
stimulation for nonunions and difficult fracture. Let’s welcome Dr. Harold Schoenhaus.
for feedback both ways. One of the advantages here is that faculty are always available. I encourage people to
come up and talk, ask questions, give suggestions. Because at the end of the day, we have one goal, and that
[Applause]
is patient improvement. And to all the things that we saw this afternoon on wounds, unbelievable. I hope they
only work as much as we are putting forth that effort on a noncompliant population. The talk I’ve selected is
Harold Schoenhaus:
electrical Thank Being
bone stimulation. you, Bob. I do want
a surgeon to state
for 45 years,that overI’ve
I think thebeen
yearsbeneath
with PRESENT,
the skin awelothave
morecertainly
than I’ve
attempted to educate and lead the profession through the educational forum and environment, providing the
been dealing with the surface of the skin. And the challenges associated with bone are equally as difficult as
state of the
that with artIt’s
skin. of what’s being done
just a different today, what’s
environment. I wasavailable,
happy toand what’s
hear in the future.
Bob talked It can’t be done
about mesenchymal effectively
stem cells,
without co-chairs of meetings such as Bob Frykberg who is a dear friend of mine, great educator,
and where they are, and what role they’re playing today. Bone marrow is one of the areas that mesenchymal and the
PRESENT
stem cells team. Obviously,
are available. Manyseeing
yearsthe amount
ago, of people
I started here on
resurfacing theafirst
Friday, I’m pleased.
metatarsal I can’tacellular
head using tell you just how
dermis
pleased I am.
and cutting I thankthe
through yousubchondral
for your time, the denuding
plate, amount ofittime you
to get tospend in the workshops
bone marrow which
or cancellous gives
bone you anfor
to allow
opportunity to spend time with the sponsors, learn new products, get a feeling for it and have the opportunity
an ingrowth of mesenchymal stem cells into acellular dermis. With the amazing results or findings that hyaline
for feedback
cartilage wasboth ways.
actually Onedeveloped
being of the advantages here dermis
into acellular is that faculty
coveringarethe
always
head available. I encourage
of a metatarsal. people to
I am certainly
come up and talk, ask questions, give suggestions. Because at the end of the day, we have one goal, and that
is patient improvement. And to all the things that we saw this afternoon on wounds, unbelievable. I hope they
https://podiatry.com/lecturehall/description/4456/Bone-Stimulation Page 5 of 9
only work as much as we are putting forth that effort on a noncompliant population. The talk I’ve selected is
electrical bone stimulation. Being a surgeon for 45 years, I think I’ve been beneath the skin a lot more than I’ve
been dealing with the surface of the skin. And the challenges associated with bone are equally as difficult as
PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

excited about mesenchymal stem cells. Alright. Disclosures. Objectives, we’re going to know about bone when
we’re done and some of the things that we can do to get through our objective goal, which is a nonunion, a
difficult fracture, fill a void, do something that’s going to enhance the healing of a fracture, and certainly an
immunocompromised patient that becomes that much more prevalent and important. We know a fracture heals
in a certain amount of time. Can we improve that? Can we change that diabetic who may have just sustained a
stress fracture on a lesser metatarsal, can’t put weight on the front of the foot, and it’s going to take a
shortened length of time for them to be able to do it? Can we improve that timeframe? Can we shorten it? Bone
stimulation is simple. It’s energy transmitted through bone to accelerate bone growth. Bone is a living tissue.
I’ve always told my students that it’s not that bone that you remember in the cadaveric lab that we used to cut
through, that was dense and dead.

excited
[05:06] about mesenchymal stem cells. Alright. Disclosures. Objectives, we’re going to know about bone when
we’re done and some of the things that we can do to get through our objective goal, which is a nonunion, a
difficult
Bone is fracture, fill a void,
a living tissue. dothe
It has something
ability tothat’s going
heal. It to enhance
has the the healing
cells to heal. of ita doesn’t
Yet, why fracture,it?
and
I’mcertainly
a surgeonan or
immunocompromised
I’d like to think I am. How patient
manythat becomes
cases that much
of delayed unionmore
have prevalent
I seen on and important.
patients Weperformed
that I’ve know a fracture
perfectheals
in a certain amount
procedures? Because of time.
everyCan we improve
surgical procedure that? Can weischange
I perform perfect.that
Then diabetic
utilize who may
all the havedevices
fixation just sustained
that wea
stress fracture
see, and on awhen
certainly lesseryoumetatarsal,
walk through can’tthis
putexhibit
weighthall,
on the front
you’ll seeofallthe
of foot, and it’s going
the methods to take
of fixation a
available.
shortened length
From internal of time for
to external, them
from to be
wires able to do
to screws, it? Can plates,
to locking we improve that timeframe?
everything that’s beenCan we shorten
thrown it? Bone
at us available
stimulation is simple.
in our surgical It’s energytotransmitted
armamentarium what? To try through
to get bone
healingto of
accelerate
bone. Notbone growth. faster
necessarily Bone isbuta get
living tissue.
bone to
I’ve
heal. We recognized that stabilizing a site is important in the healing process. Angiogenesis is an important cut
always told my students that it’s not that bone that you remember in the cadaveric lab that we used to
through, that wasSome
factor in healing. densemicromotion
and dead. may be important in the healing process depending upon the type of union
you’re trying to obtain or fracture type you’re trying to heal. Indications for bone stem are nonunions, delayed
[05:06]
unions, fresh fractures, Charcot osteoarthropathy. We talked about direct current, capacitive coupling, inductive
coupling, and ultrasound. Just as in the wound care arena, there are different materials to use. There are
Bone is amodalities
different living tissue.
thatItare
hasavailable
the ability
toto heal.
deal It has
with the cells to of
the stimulation heal. Yet,Historically,
bone. why it doesn’t
I’m it?
notI’m a surgeon
going to boreor
you
I’d
withlike
all to
of think
these.I am.
But How manyyou
certainly, cases
can of delayed
read union have
the literature I seen on
by Yasuda andpatients
BeckerthatandI’ve performed
Bassick talkingperfect
about first
procedures? Because every surgical procedure I perform is perfect. Then utilize all
modern report of electric methods being used to heal nonunion, and actually by the medial malleolus. One the fixation devices that of
we
see, and certainly
the areas when where
in the country you walk through
a lot of the this
workexhibit hall, you’ll
was originally seewas
done all ofthe
theUniversity
methods of of Pennsylvania,
fixation available.
which
From internal to external, from wires to screws, to locking plates, everything that’s been thrown
thankfully I’m on the staff at Penn Presbyterian Medical Center in Philadelphia. So a little bit of history always at us available
in our surgical
makes you feelarmamentarium torecognized
a little better. We what? To try to get
there arehealing of bone.
electrical Not necessarily
components faster but
in bone healing, get bone
Wolff’s to
law. Bone
heal.
adaptsWetorecognized that stabilizing
introduce stress. a site is important
And stress-generated in the create
potentials healingthese
process.
smallAngiogenesis is anwhich
electric currents, important
can
factor
change as bone starts to heal or adapt. Ability of crystals to produce a voltage when subjected to stress,ofthat’s
in healing. Some micromotion may be important in the healing process depending upon the type union
you’re trying towith
what happens obtain or fracture
bone. We can type you’re
actually trying it.
measure to Bone
heal. Indications for bone
contains calcium stem arecrystals,
phosphate nonunions, delayed
making it
unions, fresh fractures, Charcot osteoarthropathy. We talked about direct current, capacitive coupling,
subject to modification by introduction of voltage. It almost goes back to one of the talks where I heard about inductive
coupling,
electrolyteand ultrasound.
imbalances Justdiabetic
in our as in the wound care
population or inarena, there are
the patient different calcium
population, materialsdepletion.
to use. There are is
If calcium
different modalitiesfor
critically important that are available
bone to deal
modification with the
healing, the calcium
stimulation of bone.
levels betterHistorically,
be good. We I’m notlook
can going to bore you
at different
with
partsall
ofof
thethese.
boneBut
andcertainly, youconcave
look at the can readorthe
theliterature by Yasuda
convex surface of aand
boneBecker and Bassick
and recognize thattalking
there’sabout first
modern report ofand
electronegative electric methods being
electropositive used
charges. Wetocan
healget
nonunion,
all kindsand actually
of fancy by the
things medial what
to identify malleolus. Onewhen
happens of
the
theseareas in the country
structures whereAnd
are stressed. a lotwe
of the
knowwork
the was originally
different stages done was the
of bone University
healing. I can of Pennsylvania,
remember which
probably 35,
thankfully I’m on the staff at Penn Presbyterian Medical Center in Philadelphia. So a little bit
40 years ago when AO/ASIF became an important component in the surgery we do. That instead of just using a of history always
makes you feel a little better. We recognized there are electrical components in bone healing, Wolff’s law. Bone
adapts to introduce stress. And stress-generated potentials create these small electric currents, which can
https://podiatry.com/lecturehall/description/4456/Bone-Stimulation Page 6 of 9
change as bone starts to heal or adapt. Ability of crystals to produce a voltage when subjected to stress, that’s
what happens with bone. We can actually measure it. Bone contains calcium phosphate crystals, making it
subject to modification by introduction of voltage. It almost goes back to one of the talks where I heard about
PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

K-wire, you need a screw across bone to create some compression. For some reason, the term compression
has led to the development of how much can I push these two segments of bone together to get compression
to be sure I get a union or a healing of the site. We don’t know that. Many times, you can get the opposite
effect by crushing bone ends and actually create osteonecrosis. We get upset sometimes when we see the
healing of an osteotomy and you say, “Oh my god, two to three weeks after the surgical procedure, I see a
space at the site that I made that little sliver of a cut. I must be going on to a potential nonunion.” When
recognizing, there’s osteoclastic activity that is taking away the necrotic bone that you created by using a saw
blade when you cut bone or cutting through a nonunion site or resecting a nonunion site.

[10:05]

K-wire,
What weyou need
think a screw
we’ve doneacross bone to create
with remodeling, somesteps
the body compression. For “I’m
in and says, somegoing
reason, the term
to help compression
you out some
has led to the development of how much can I push these two segments of bone
more,” by this osteoclastic activity which is going to be imperative before we’re going to get osteoblastic together to get compression
to be sure I get a union or a healing of the site. We don’t know that. Many times, you can get the opposite
activity and ultimately osteogenesis and ultimate healing. I’m not going to bore you with different phases and
effect by crushing bone ends and actually create osteonecrosis. We get upset sometimes when we see the
when you can expect things to happen. But patients are pain in the butt sometimes. They are ones that broke a
healing of an osteotomy and you say, “Oh my god, two to three weeks after the surgical procedure, I see a
bone or they are the ones that have caused a nonunion, and the first question is, “Well, how long is it going to
space
take toatheal?”
the site
I’mthat I made
going thattolittle
to have be insliver
a castof aorcut.
Cam I must be or
walker going
in a on to a potential
mobilizer for 6 tononunion.”
8 or 12 weeks.When Lapidus
recognizing, there’s osteoclastic activity that is taking away the necrotic bone
procedures have become very much in vogue with bunion surgery. And now, we have got plates and screws that you created by using a saw
blade when you cut bone or cutting through a nonunion site or resecting a nonunion site.
and this thing is going to be completely stabilized. We just created an Eiffel Tower around the site for no motion
to occur. And the reason? The patient wants to be able to walk faster. Does that imply that that bone is going to
[10:05]
heal any quicker? Not necessarily. We’re just happy to know it’s stable and we’re going to let them walk. The
patient is dictating our protocols, which I’ve never felt comfortable in allowing a patient to determine that.
What we think
Nonunions we’ve done
unfortunately with remodeling,
occur. What are thethe body
risks steps Smoking.
factors? in and says, “I’mcountry,
In this going tounbelievable.
help you out Philadelphia,
some
more,” by this osteoclastic activity which is going to be imperative before we’re going to get osteoblastic
they come in with packs of cigarettes attached to their crotches so they can smoke. Immunosuppressive drugs,
activity and ultimately osteogenesis and ultimate healing. I’m not going to bore you with different phases and
diabetes, obesity, alcoholism, previous operations, hormone depletions, use of illicit drugs, age, nutrition. It
when you can expect things to happen. But patients are pain in the butt sometimes. They are ones that broke a
goes on and on. The etiology of risk factors is almost everything we see everyday in our patient population. And
bone or theywhy
we wonder arewe
thesometimes
ones that havehavecaused a nonunion,
these potential and the firstWe
complications. question
look at is, “Well, how
smoker’s risk long is it going
of fracture, in to
take to heal?”
smokers is twoI’mto going to have
six times to be
greater thatinitareduced
cast or Cam bonewalker or Significantly
density. in a mobilizerhigher
for 6 to 8 or 12
number ofweeks.
nonunions.Lapidus
If I
procedures have become very much in vogue with bunion surgery. And now, we have got plates and screws
tell my patient to stop smoking, they laugh. Not going to happen. Pseudarthrosis, four times greater on
and this thing is going to be completely stabilized. We just created an Eiffel Tower around the site for no motion
nonsmokers. You eventually reach your point in time when you begin to see difficult fractures and difficult
to occur. And the reason? The patient wants to be able to walk faster. Does that imply that that bone is going to
problems and recognize that these are potentially immunosuppressed. They’re going to continue to smoke and
heal anyanything
is there quicker?we Not necessarily.
can We’re some
do to stimulate just happybone to know it’s stable
production. Direct and
bonewe’re going
current to let them
stimulation walk. The
increases
patient
amountisofdictating our free
intracellular protocols,
calcium, which
andI’ve never felt
hydrogen comfortable
peroxide in allowing
generation a patientresulting
at the cathode to determine that.
an increased
Nonunions unfortunately occur. What are the risks factors? Smoking. In this country, unbelievable. Philadelphia,
pH. It’s invasive. You’re implanting a battery and leads into the area. Direct current bone stimulation is a little bit
they come in with packs of cigarettes attached to their crotches so they can smoke. Immunosuppressive drugs,
different, making the device active for a period of 6 to 12 months. Here’s an example of a bone stimulator that I
diabetes, obesity, alcoholism, previous operations, hormone depletions, use of illicit drugs, age, nutrition. It
used which I implant. It’s got a cathode and it’s got the battery. And actually, they have dual leads that come
goes onThe
from it. andadvantage,
on. The etiology
I don’tofhave
risk to
factors
worryisabout almosttheeverything we see
patient using everyday
it. It’s in ourI’m
in the bone. patient
goingpopulation.
to show you And
we
that.wonder why we sometimes
Disadvantages, it has to comehaveout these potential
if it’s annoying complications. We
to the patient. Atlook
6 to at
12smoker’s
months, risk of fracture,
it’s done. in it’s
It’s used,
smokers is two to six times greater that it reduced bone density. Significantly higher number of nonunions. If I
done its effectiveness. You may have painful prominence where the battery is inserted and I’ll show you some
tell my patient to stop smoking, they laugh. Not going to happen. Pseudarthrosis, four times greater on
of that. On a more difficult case, here’s a Charcot. We’re doing everything we can to prepare these joint
nonsmokers. You eventually reach your point in time when you begin to see difficult fractures and difficult
problems and recognize that these are potentially immunosuppressed. They’re going to continue to smoke and
https://podiatry.com/lecturehall/description/4456/Bone-Stimulation Page 7 of 9
is there anything we can do to stimulate some bone production. Direct bone current stimulation increases
amount of intracellular free calcium, and hydrogen peroxide generation at the cathode resulting an increased
pH. It’s invasive. You’re implanting a battery and leads into the area. Direct current bone stimulation is a little bit
PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

surfaces, replacing bone, using any other type of material that I’m going to use to fill the voids which is a dust
disaster. You got to get necrotic bone out. Position everything in place with your hardware. Then I use a bone
stimulator. Here’s an example of an ankle fusion. There’s a TTC rod and you could see the little wire because
the elements of the cathode are actually in the joint surface. You’re getting compression as well as the actual
implant that’s in place. Here’s an example of me putting in those dual leads into an ankle joint. You can use
other materials, bone stimulating materials. This is an allomatrix which is placed into the joint, holds everything
in place.

[15:05]

Here’s your external fixator on. Give yourself the compression. The beauty of external fix is that as you see
surfaces, replacing bone,
areas of dissolution of bone,using
youany
canother typetighten
actually of material that I’m fixer
the external going to use
a little bit.toIffill
youtheget
voids which isyou
resistance, a dust
disaster. You got to get necrotic bone out. Position everything in place with your hardware. Then I use a bone
know that you don’t need to do anymore. There’s a complication that I had on one of my patients. The battery
stimulator. Here’s an example of an ankle fusion. There’s a TTC rod and you could see the little wire because
pack was in place deep enough. It’s supposed to be between muscle and bone. She was a diabetic. She came
the elements of the cathode are actually in the joint surface. You’re getting compression as well as the actual
in and she said, “I think I have a little problem on my leg.” I said, “You’re right about that.” We had to take that
implant
bone out, that’s
thatin place.pack
battery Here’s anHere’s
out. example an of me putting
example in those
of a dowel duala leads
graft, bone into
dowel anthat’s
ankle used.
joint. You
Thiscanis a use
medial
other materials, bone stimulating materials. This is an allomatrix which is placed into
malleolar fracture nonunion. You actually wrap the cathode around the dowel graft. Here it is in place, battery in the joint, holds everything
in place.
place, and you go on to a beautiful union. Alright, we’re using the component. The dowel graft actually gives
you tremendous compression by just placing that across the site and then the electrical stimulation goes
[15:05]
beyond that. Capacitive coupling, ability of a device to store an electrical charge. We have two charge placed to
generate a flow of current. One of the companies, OrthoPAC, was one of the devices that have been utilized
Here’s yourjust
where you external
placefixator on. Give
these little padsyourself the of
by the site compression.
nonunion orThe beauty
delayed of external
union. Compliances fix is that as youbecause
of factor see
areas of dissolution of bone, you can actually tighten the external fixer a little bit. If you get resistance, you
this guy, he had to put on 24 hours a day. I don’t know any patient that is that compliant in my practice. My wife
know that you don’t need to do anymore. There’s a complication that I had on one of my patients. The battery
is not that compliant. Inductive coupling bone stem is another component with magnetic field using coils to
pack was in place deep enough. It’s supposed to be between muscle and bone. She was a diabetic. She came
deliver flow at the site of osseous interest and healing of the nonunion. We have combined magnetic field and
in and she
pulsed said, “I think Ifield.
electromagnetic haveOnce
a littleagain,
problem ongoing
we’re my leg.” I said,
to need time“You’re rightthings
for these about to that.”
work.WeHere’s
had toantake that
example
bone out, electromagnetic
of pulsed that battery packfields.
out. Here’s
Thesean example
usually of a8dowel
run for graft, aa bone
to 12 hours dowel
day. The that’s used.
Physio-Stim This
light onisthea medial
bottom
malleolar fracture nonunion. You actually wrap the cathode around the dowel graft. Here it is in place, battery in
is three hours a day. Now most of these devices have the ability to show you how many hours the patient has
place, and you go on to a beautiful union. Alright, we’re using the component. The dowel graft actually gives
truly been using these bone stimulators. The patients are kind of smart. They could probably just turn it on and
you tremendous compression by just placing that across the site and then the electrical stimulation goes
put it on around a broomstick and then go out and do what they want. They come into your office saying, “Let’s
beyond that.Oh,
take a look. Capacitive
you’ve beencoupling,
doingability
it veryofwell,
a device
8 to 12to hours
store an electrical
a day, charge. happening.”
but nothing’s We have twoWhy charge placed to
is that?
generate a flow
Then the wife orof
thecurrent.
husband, One“I’ll
of the
havecompanies,
to tell you theOrthoPAC, was one
truth, doctor. Sheofhasn’t
the devices
really been that have been utilized
that compliant.”
where you just place these little pads by the site of nonunion or delayed union. Compliances of factor because
Alright, here’s another magnetic field through sinusoidal pattern. The advantages can be placed over a cast or a
this guy, he had to put on 24 hours a day. I don’t know any patient that is that compliant in my practice. My wife
dressing with these pump systems. Disadvantage, as I say, is the compliance. Ultrasound, beautiful, I love it.
is not that compliant. Inductive coupling bone stem is another component with magnetic field using coils to
Use of acoustic radiation above the limit of human hearing, by the way. They don’t feel anything, they don’t
deliver flow at the
hear anything. Andsite
oneofofosseous interest
the beauties and healingisofyou
of ultrasound theput
nonunion. Wesite
it over the have forcombined
20 minutes. magnetic
I’m notfield and
dealing
pulsed
with 8 toelectromagnetic field. OnceHow
12 hours of compliance. again, we’re going
affective is this to
typeneed time for theseNumber
of technology? things to of work.
years Here’s an down
ago, I fell examplea
of pulsed electromagnetic fields. These usually run for 8 to 12 hours a day. The Physio-Stim light on the bottom
flight of stairs coming out of a wedding at the Bellevue-Stratford Hotel and cracked three ribs. And went to the
is three hours a day. Now most of these devices have the ability to show you how many hours the patient has
hospital Monday morning and said to my resident, wrap me up as much as you can with ACE bandages. I told
truly been using these bone stimulators. The patients are kind of smart. They could probably just turn it on and
the tech, get me X-rays of my ribs. Say, yeah, you got three fractures. I called the rep. I said, “Get me this bone
put it on around a broomstick and then go out and do what they want. They come into your office saying, “Let’s
take a look. Oh, you’ve been doing it very well, 8 to 12 hours a day, but nothing’s happening.” Why is that?
https://podiatry.com/lecturehall/description/4456/Bone-Stimulation Page 8 of 9
Then the wife or the husband, “I’ll have to tell you the truth, doctor. She hasn’t really been that compliant.”
Alright, here’s another magnetic field through sinusoidal pattern. The advantages can be placed over a cast or a
dressing with these pump systems. Disadvantage, as I say, is the compliance. Ultrasound, beautiful, I love it.
PRESENT Podiatry Online CME & Conferences | Bone Stimulation 8/26/18, 9)46 PM

stimulator.” I put one of these things over each of my ribs. I was miserable for three weeks. But if anybody here
has ever sustained a rib fracture, not a happy camper. Three weeks I was playing golf. It became very apparent
to me that 20 minutes was pretty damn effective. I couldn’t imagine wrapping a coil around my body with a
pulsed electromagnetic component. Here is the ultrasound, 20 minutes a day. No effect on metallic implant
presence. Doesn’t have any problem with it. It’s not based on thermal effects. And in a micro level ultrasound
appears to stimulate the production of prostaglandin in E2. Here’s an example of a patient in a cast. You can
actually window the cast and place these little devices on both sides of the foot. For 20 minutes a day it has to
be activated.

[20:09]

stimulator.” I put onevery

That to me requires of these things over
little patient each of my
compliance. Theribs. I was
effects miserable
of it fordramatic.
have been three weeks. ButWhen
Alright. if anybody
we look here
at
has ever sustained a rib fracture, not a happy camper. Three weeks I was playing golf. It became very apparent
what happens with stimulation activation and upregulation of COX-2, it’s unbelievable the effect, alright? It
to me that
affects 20 minutessoft
inflammation was prettyhard
callus, damn effective.
callus, I couldn’t
and bone imagineNow
remodeling. wrapping a coil around
the iatrogenic fibulamy body with
fractures, a
I’ll hold
pulsed
off that electromagnetic
last comment forcomponent. Here isan
a moment. Here’s theexample
ultrasound,
of a 20 minutes
fibular a day.
fracture. DoNoall effect on metallic
the hardware youimplant
want in
presence. Doesn’t have any problem with it. It’s not based on thermal effects. And in a micro level ultrasound
place. These are difficult areas. The vascular supply is limited. And they go on to a beautiful healing. Here is s
appears to stimulate
patient with an agilitythe production
ankle. Look at oftheprostaglandin
fibular fracturein on
E2.the
Here’s
left. an
Weexample
actually of a patient
went in and in a cast.
put Yourod
a fibular canup
actually window the cast and place these little devices on both sides of the foot. For 20 minutes a day it has to
the fibula to realign the position of the joint, a bone stem on the outside. And there you go on to a beautiful
be activated.
healing. Here’s other fracture. These are all with OsteoGen or the Exogen battery pack. There is over hardware.
We were even doing studies about AVN of the talus. I think one of the most important things that we can look at
[20:09]
is indications for these different bone stimulators. You just heard a talk about the fact that reimbursement is a
major problem. Well, actually, Exogen is the only one that is indicated in fresh fractures. And it’s indicated in
That to me requires very little patient compliance. The effects of it have been dramatic. Alright. When we look at
nonunions right off the bat. That to me makes a lot of sense in how I go about dealing with my complicated
what happens
nonunions andwith stimulation
non-heal activation
fractures. I thankandyouupregulation
for your time.of COX-2, it’s unbelievable the effect, alright? It
affects inflammation soft callus, hard callus, and bone remodeling. Now the iatrogenic fibula fractures, I’ll hold
off that last comment for a moment. Here’s an example of a fibular fracture. Do all the hardware you want in
place. These are difficult areas. The vascular supply is limited. And they go on to a beautiful healing. Here is s
patient with an agility ankle. Look at the fibular fracture on the left. We actually went in and put a fibular rod up
the fibula to realign the position of the joint, a bone stem on the outside. And there you go on to a beautiful
healing. Here’s other fracture. These are all with OsteoGen or the Exogen battery pack. There is over hardware.
We were even doing studies about AVN of the talus. I think one of the most important things that we can look at
is indications for these different bone stimulators. You just heard a talk about the fact that reimbursement is a
major problem. Well, actually, Exogen is the only one that is indicated in fresh fractures. And it’s indicated in
nonunions right off the bat. That to me makes a lot of sense in how I go about dealing with my complicated
nonunions and non-heal fractures. I thank you for your time.

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