## 2 Applications
### Nonunions
All fractures healed in a mean time of 4 months (range 2-8 months), with no refractures, nor recurrence of symptoms and no further requirements of additional interventions. Three patients after receiving PEMF fields were placed in a non-weight bearing cast and healed in a mean time of three months. Authors compared the healing time of delayed unions and nonunions proximal fifth metatarsal treated in other ways such as cast with non-weight bearing, bone graft, and screw fixation in other studies and concluded that the use of PEMFs provided for healing in a comparable or shorter time and without complications when compared with immobilization alone or surgery [45; 47; 48; 49]. [PERSON] et al. [50] conducted a prospective, randomized, double-blind trial on 8 patients diagnosed with a fifth metatarsal delayed or nonunion, with no progressive signs of healing for a minimum of 3 months. Patients were randomized to receive either an active stimulation or placebo PEMFs device. All patients underwent an open biopsy of the fracture site and was fitted with the appropriate PEMFs device. The biopsy was analyzed for messenger-ribonucleic acid (mRNA) levels. The patients were followed at 2- to 4-week intervals with X-rays and were graded by the number of cortices of healing. After 3 weeks, the patients underwent repeat biopsy and open reduction and internal fixation of the nonunion site. A significant increase in placental growth factor (PIGF) level was found after active PEMF treatment (\(p\) = 0.043). Authors reported that all fractures healed, with an average time to complete radiographic union of 14.7 weeks and 8.9 weeks for the inactive and active PEMF groups, respectively. Results lead to the conclusion that the adjunctive use of PEMF for fifth metatarsal fracture nonunion produced a significant increase in local factors and faster average time to radiographic union compared to unstimulated controls. The characteristics of PEMFs in the treatment of foot and ankle nonunion have been confirmed by other authors not only in the field of fractures. [PERSON] et al. [51] reported the case of a 42-year-old woman affected by a nonunion of the first metatarsal bone after percutaneous distal osteotomy for hallux valgus deformity. The patient was surgically treated with debridement of the fibrous nonunion with plating followed by the application of PEMFs, and achieved bone consolidation within 3 months. Current applications of PEMFs for nonunions are summarized in Table 4. \begin{table}
\begin{tabular}{l l l l} \hline
**Disease** & **Study** & **Characteristics** & **Results** \\ \hline Nonunions & [PERSON] et al. [43] & Intensity: 0.008 Weber/m\({}^{2}\) & 35\% (\(n\) = 16) of cases showed union in 10 weeks \\ \hline  & & Intensity: burst consisting of & \\  & & 20 magnetic field pulses with & \\  & & anincreasingphase (0–20 gauss) of 200 & \\  & [PERSON] et al. [46] & psec duration and a decreasing phase & Healing in a comparable or shorter \\  & & of 20 gsec followed by a 5-psec pause & time course and with no \\  & & Frequency: pulse burst of 4.5 msec & complications \\  & & duration repeated at 15 Hz & \\  & & Duration: 8–10 h/day & \\ \hline \end{tabular}
\end{table} 
Table 4: Summary of studies related to nonunions.