LAUSR

Buono et al. [1] have written an interesting paper about post-operative pulsed electromagnetic field (PEMF) application. In this observational study, the author used PEMF on the patients undergoing nailing fixation for diaphyseal fractures of the tibia. In their conclusion, the authors find PEMF application after intramedullary nailing is safe and reduces post-operative pain, the use of analgesics, and the time of healing fracture in the early stage. It is undeniable that PEMF stimulation can accelerate fracture healing and early recovery, and this paper provides essential evidence in the field of orthopaedic trauma [2]. However, some critical issues need further consideration in this study. Firstly, the title indicates that the design of this study is a “case control study.” However, we find it is a classical retrospective cohort study in the section of methods and results. The author divided patients into two groups according to the exposure of factor (PEMF) in the cohort study, not the patients/controlled groups in the cohort case–control study. Thus, the title of this study is against the design of methods. Secondly, the author said that demographic and clinical data were shown in, and the causes of fracture, the fracture classification, and affected side were all recorded in Table 1. However, there was a short of these essential data in two groups. Table 1 was not incomplete. Why do I pay attention to this issue? This is because the prerequisite for reaching a difference is good comparability between groups, especially in an observational study [3]. In the text and Table 1, the author did not show fracture classification and pain assessment data. As for fracture classification, there were 10 A2, 8 A3, 12 B1, 14 B2, 3 C1, and 3 C2, but we did not know whether the fracture classification of the two groups was comparable. The average healing time varies from four weeks to more than 16 weeks, depending on the location, the mechanism of injury, and the degree of soft tissue disruption [4]. The fracture healing time may vary in simple, wedge, and complex fractures. As for pain assessment, whether the pre-operative VAS is comparable between the two groups. We did not know the pre-operative VAS or the use of pre-operative analgesics. The author reported that the use of analgesics was reduced by comparing analgesics in post-operative three months. If there was someone who used analgesics before the operation, it should be reported. Although the study controlled many confounding factors that may affect the results, the above crucial basic information is unclear, and the efficacy of PEMF may be exaggerated. Even though this study had some limitations, it is a meaningful study on PEMF accelerating fracture healing.