## 2 Application Fields
### Bone Healing  
Several studies in the literature support the effectiveness of biophysical stimulation with electromagnetic fields to obtain bone consolidation following a traumatic event. PEMFs' stimulation has two main areas of application. First of all, they can be use in acute fractures and, secondly, when a fracture may be at risk of non-healing due to intrinsic and/or extrinsic factors [18]. The double-blind prospective randomized study conducted by [PERSON] et al. [19] in 2010 presented valid results in patients undergoing osteosynthesis surgery with canulated screws for fractures of the femoral neck Garden 1, 2, or 3 type. The application of PEMFs is started 7 days after surgery with a treatment protocol for 8 h for 90 days. Radiographic healing was observed in 94% of treated cases vs. 69% of patients in the placebo group. Furthermore, in the placebo group, a higher percentage of osteonecrosis and higher scores in the VAS pain assessment were observed. Similarly, a study was conducted by [PERSON] et al. [20] in 2012 on 44 fractures involving the diaphysel portion of the tibia with delay or non-union without ongoing infectious phenomena. Patients were treated with PEMFs for 3 h/day for a maximum of 36 weeks (average of 29.5 weeks). Fracture union was confirmed in 34 cases (77.3%). Its success is not associated with a specific fracture or patient-related variables; although, statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (\(p\) = 0.081). The author concludes that PEMFs stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. In 2010, [PERSON]. et al. [21] conducted a study of tibial diaphysis fractures in non-union. In these patients, 6 months after surgery, an X-ray of absence of bone callus was observed. Clinically, they had palpation pain and preternatural mobility at the site involved. Fifty-seven patients were included in two groups. All patients had undergone endomedullary nail osteosynthesis, but only a group of 22 patients were treated with PEMFs. The remaining therapeutic protocol overlapped in the two groups. The biophysical stimulation involved the use of electromagnetic fields for 8 h/day for an average of 5.6 months. Every month, a clinical and radiographic check was performed for a minimum follow-up which lasted for 6 months. In the PEMFs group, there was recovery of 20 patients (91%) vs. 29 patients that were healed in the control group (83%). The mean time for radiographic evidence of a fracture union was 3.3 months in the PEMFs group, while it was 4.9 months in the control group (\(p<0.05\)). Correlations with possible bone exposures are also considered in the results, and they are evaluated by [PERSON]'s classification as the age, sex, and etiology of the individual with the fracture. The authors, therefore, declare that there is no statistically significant correlation between the use of PEMFs and union of thefracture, but it was clinically significant (relative risk 0.53, which supposes a reduction of 47% in the appearance of events). Moreover, there is a significant correlation between time to union of the fracture and the use of the stimulator and between the union of the fracture and [PERSON]'s classification, i.e., the greater the degree of the soft tissue injury, the lower the percentage of the union. To facilitate the choice regarding the application of biophysical stimulation, an algorithm called FRACTING SCORE to predict bone healing in a specific body area, i.e., the tibia, was published by [PERSON] et al. [22]. This study involved the recruitment of patients from 41 Italian orthopedic traumatology centers. Final targets were identified to make the evaluation homogeneous, and a 12-month follow-up was identified. Within 12 months from trauma, the date at which the fracture healed was used to calculate days and months elapsed since treatment called \"healing time\".