Thurs., 10/14/10 Basic Science, Paper #35, 4:28 pm OTA-2010
The Effect of Pulsed Electromagnetic Field (PEMF) upon Diabetic Fracture Healing
Elan Goldwaser, BS; Ravi Verma, MD; David Paglia, PhD; Eric A. Breitbart, MD;
Sharonda Meade, PhD; Siddhant Mehta, MD; Christopher Ojeda, BS; Anne Marie Simon, PhD;
Ankur Gandhi, PhD; Sheldon S. Lin, MD;
UMDNJ: New Jersey Medical School, Newark, New Jersey, USA
Purpose: Diabetes mellitus (DM) has been associated with impaired fracture healing including cellular proliferation resulting in inferior mechanical properties. Pulsed electromagnetic fields (PEMF) have been used in the clinical setting to enhance fracture healing since the 1970s. Therefore, this purpose of this study was to evaluate the role of PEMF in DM fracture healing
Methods: Animals. BB Wistar nondiabetic (non-DM) and diabetic (DM) animals were used for this study. Surgical Procedure. A 4-mm incision was made over the patella and a 1.1-mm 40-gauge Kirschner wire was inserted into the femur. After an intramedullary fixation, a closed, middiaphyseal transverse fracture was created with a three-point bending machine, which was confirmed by radiography and the appropriate treatment applied. One day following surgery, animals were placed for up to 8 hours a day in cages and PEMF treatment applied. Experimental Animal Groups. The animal groups consisted of a non-DM group without PEMF, an insulin-treated, poorly controlled diabetic animals group without PEMF, and the last group consisted of insulin-treated, poorly controlled diabetic animals with PEMF. Local levels of growth factors were measured on day 7 and determined using ELISA (enzyme-linked immunosorbent assay) specific for rat platelet-derived growth factor (PDGF)-AB, transforming growth factor (TGF)-β1, insulin growth factor (IGF)-1, and vascular endothelial growth factor (VEGF). At 6 weeks, animals were sacrificed for mechanical testing. Early histomorphometry and cell proliferation analysis using BrDU staining were performed at 4 and 7 days postfracture.
Results: Cellular Proliferation Analysis. A significant increase in BrDU-positive cells were
seen in the DM group with PEMF treatment compared with the DM control group at both 4
and 7 days (P < 0.001). Early Histomorphometry. A significant increase in cartilage production
was observed in DM animals with PEMF treatment at 4 days compared to DM controls (P <
0.001). Mechanical Testing. At week 6 postfracture, a significant increase in torque to failure
(P < 0.001) was seen compared to the DM control group. A significant difference in stiffness
(P = 0.006) and % average stiffness (P = 0.03) existed between DM, PEMF-treated animals
compared to DM controls. Growth Factor Levels in Callus Area. At day 7 postfracture, diabetic
rats that had received PEMF treatment showed significant increases in PDGF-AB (P = .006),
IGF-1 (P = .002), and VEGF (P < .001) levels in the fracture callus when compared to diabetic
rats that had not received any PEMF treatment. There was a significant decrease in TGF-β1 (P
< .001) levels in DM animals receiving PEMF treatment when compared to DM controls
Conclusion: DM rats treated with PEMF had significantly increased PDGF, IGF-1, and VEGF levels in the fracture callus as well as significantly improved mechanical and early histological parameters. This study justifies a role for PEMF in the treatment of diabetic fractures.
Alphabetical Disclosure Listing (292K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.