From the Guidelines
Bone stimulators are not recommended as a first-line treatment for sesamoid fractures in the foot, but may be considered for high-risk fractures or those with delayed healing, based on the most recent evidence from 2024 1. When considering the use of bone stimulators for sesamoid fractures, it's essential to evaluate the risk of fracture completion and the potential for nonunion or delayed union. According to the American College of Radiology's 2024 update on stress fractures, certain stress fractures are considered high-risk based on their tendency for nonunion or delayed union, including the tibial hallux sesamoid 1.
- Key factors to consider when evaluating the use of bone stimulators for sesamoid fractures include:
- The patient's overall health and risk factors for poor bone healing, such as osteoporosis or bisphosphonate therapy
- The severity and location of the fracture
- The presence of any underlying conditions that may affect bone healing, such as diabetes or smoking
- In cases where bone stimulators are deemed necessary, either ultrasonic or electromagnetic devices may be used, typically for 20-30 minutes daily over a period of 3-6 months, as part of a comprehensive treatment plan that includes immobilization, non-weight bearing, and possibly anti-inflammatory medications for pain management 1.
- It's crucial to note that bone stimulators should only be considered when a sesamoid fracture shows delayed healing after 4-6 weeks of conventional treatment or for patients with risk factors for poor bone healing, as they are not a replacement for standard treatment protocols 1.
From the Research
Bone Stimulator Use for Sesamoid Fracture in Foot
- The use of bone stimulators for sesamoid fractures in the foot has been explored in various studies 2.
- A case study published in 2007 reported the successful use of an inductive coupling external bone stimulator with pulsed electromagnetic field to treat a delayed-union fracture of the lateral sesamoid in a dancer 2.
- The treatment included activity and weight-bearing restrictions, protective padding, strengthening, functional retraining, and progressive return to dance, resulting in the dancer's full functional recovery after 12 months of using the external bone stimulator 2.
- Other studies have discussed the use of bone stimulators for fracture healing in general, including electrical and electromagnetic stimulation, ultrasound, and extracorporeal shock waves 3, 4.
- Low-intensity pulsed ultrasound (LIPUS) has been shown to be effective in treating delayed unions and nonunions, with a highly rated RCT demonstrating significantly improved consolidation of midshaft tibial fractures using LIPUS 5.
- However, the effectiveness of bone stimulators for sesamoid fractures specifically may depend on various factors, including the type and severity of the fracture, as well as the individual patient's overall health and compliance with treatment 2, 6.