## 2 Applications
### Nonunions  
The definition of nonunion is a fracture that persists for a minimum of 9 months without healing signs for three months [42]. Delayed unions or nonunions have a substantial clinical, economic, and quality of life impact. Due to their characteristics, PEMFs have been applied to the treatment of nonunions  
[PERSON] and al. conducted a study on 45 tibial fractures with established atrophic nonunion treated by PEMFs [43]. All patients had abnormal mobility and no or slight gap at the fracture site with no evidence of callus formation. PEMFs was given using above-knee plaster cast (0.008 Weber/m\({}^{2}\) magnetic field was created for 12). The average duration for PEMFs therapy was 8.35 weeks, with the range being 6-12 weeks. About 35% of cases (\(n=16\)) showed union in 10 weeks, and 85% (\(n=38\)) of cases showed union in 4 months. Authors concluded that PEMFs are a useful noninvasive treatment option for difficult nonunion of long bones. As reported by [PERSON] et al., PEMFs are an effective treatment for delayed unions and nonunions, but their efficacy in preventing healing complications in patients with acute fractures is largely untested [44]. In a double-blind randomized trial, 259 participants with acute tibial shaft fractures were randomized by means of external allocation to externally identical active and inactive PEMFs devices. Participants were instructed to wear PEMF for 10 h/day for 12 weeks. The primary outcome was the proportion of participants requiring a secondary surgery because of delayed union or nonunion within 12 months after the injury. Secondary outcomes included surgical intervention for any reason, radiographic union at 6 months, and the Short Form Health Survey 36 (a 36-item, patient-reported survey of patient health), Physical Component Summary, and Lower Extremity Functional Scales at 12 months. Two hundred and eighteen patients (84%) completed the follow-up. One hundred and six patients were allocated to the active device group, and one hundred and twelve to the placebo group. Compliance was reported to be 6.2 h/day of average. Overall, 16 patients in the active group and 15 in the inactive group experienced a primary outcome event (risk ratio, 1.02; 95% confidence interval, 0.95 to 1.14; \(p=0.72\)). According to the per-protocol analysis, there were 6 primary events (12.2%) in the active, compliant group and 26 primary events (15.1%) in the combined placebo and active, noncompliant group (risk ratio, 0.97; 95% confidence interval, 0.86 to 1.10; \(p=0.61\)). No differences between-groups were found with regard to all the considered parameters. Authors concluded that adjuvant PEMFs stimulation does \begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline
**Disease** & **Study** & **Characteristics** & **Results** \\ \hline \multirow{3}{*}{Fractures} & \multirow{3}{*}{[PERSON] et al. [38]} & - & Less pain and lower rates of \\  & & (meta-analysis) & radiographic nonunion or \\  & & & persistent nonunion \\ \hline \multirow{3}{*}{[PERSON] et al. [39]} & - & Moderate increasing in healing rate \\  & & (systematic review and meta-analysis) & and relieved pain of fracture \\ \hline \multirow{3}{*}{[PERSON] et al. [40]} & \multirow{3}{*}{Peak intensity: 2.5 mT Frequency: 75 Hz Duration: 8 h/day until the 42 nd postoperative day} & \multirow{3}{*}{Better radiographic healing rates and pain control with less edema} \\  & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Summary of studies related to fractures. not prevent secondary surgical interventions for delayed union or nonunion and does not improve radiographic union or patient-reported functional outcomes. For what it may concern foot and ankle nonunions, main applications of PEMs involve proximal fifth metatarsal fractures, especially Jones fractures, and diaphyseal stress fractures [45]. [PERSON] et al. [46] treated 9 delayed unions and nonunions of the proximal fifth metatarsal with PEMFs.