## 2 Applications
### Fractures  
Sports traumas, because of high-intensity forces, may lead to complex foot and ankle fractures.  
PEMFs are generally known for accelerating fresh fractures healing by stimulating growth factors and cytokines production, [36] and increasing angiogenesis and perfusion [37].  
[PERSON] et al. [38] conducted a meta-analysis of randomized controlled trials with sham group to determine the efficacy of electrical stimulation for bone healing, identifying only those trials in which patients were randomized into the stimulated or placebo group. Patients treated with electrical stimulation as an adjunct for bone healing have less pain (mean difference (MD) on 100-mm visual analogue scale = \(-\)7.7 mm; 95% CI \(-\)13.92 to \(-\)1.43; \(p\) = 0.02) and are at reduced risk for radiographic nonunion by 35% (95% CI 19% to 47%; number needed to treat = 7; \(p\) < 0.01).  
More recent results were reported in a systematic review and meta-analysis of randomized controlled trials performed by [PERSON] et al. [39]. On 1131 participants, PEMF treatment increased overall healing rate with a risk ratio of 1.22 (95% CI = 1.10-1.35), but only marginal significance in healing time (\(\text{SMD}=-1.01\); 95% CI = \(-\)2.01 to \(-\)0.00; 1 Z = 90%). PEMFs showed better pain relief (\(\text{SMD}=-0.49\); 95% CI = \(-\)0.88 to \(-\)0.10; 1 Z = 60%) [39].  
Up today, there are no studies evaluating the role of PEMFs in the setting of acute foot and ankle fractures.  
However, there are studies that have evaluated the role of PEMFs after metatarsal osteectomies. As a matter of fact, osteectomies can be considered a good repeatable fracture model in order to reduce variability.  
[PERSON] et al. [40] conducted a study in 60 patients percutaneousally treated with osteectomies for hallux valgus and metatarsalgia and stimulated with PEMF. The treated group showed better radiographic healing rates and pain control with less edema. The author concluded that early application of PEMF would appear particularly beneficial to  
\begin{table}
\begin{tabular}{l l l l} \hline \hline
**Disease** & **Study** & **Characteristics** & **Results** \\ \hline \multirow{4}{*}{Osteochondral defects} & & Peak intensity: 1.5 mT & \\  & & Frequency: 75 Hz & Pain control and a better clinical \\  & & Duration: 4 h/day for 60 days & outcome after surgery \\  & & starting within 3 days after surgery & \\ \hline \multirow{4}{*}{[PERSON] et al. [30]} & Peak intensity: 1.5 mT vs. placebo & \multirow{2}{*}{Earlier resumption of sports after} \\  & & peak\textbackslash{}0.05 mT & \\ \cline{1-1}  & & Frequency: 75 Hz & \\ \cline{1-1}  & & Duration: 4 h/day for 60 days & \\ \hline \hline \end{tabular}
\end{table}
Table 2: Summary of studies related to OCD.  
selected patients with high activity levels by reducing pain, disability, convalescence time, and return to work after surgery. A faster recovery could be also a cost-saving solution.  
Despite there is still a moderate quality evidence in the current literature [39], PEMFs can be beneficial in the treatment of acute fractures regarding time to radiological and clinical union (Table 3), therefore, should be considered as a valid option, in particular when dealing with athlete patients [41].