Evaluating the effectiveness of pulsed electromagnetic field stimulation on bone fracture-related healing through in vitro experiments and computational modelling

Bone fractures are one of the most commonly occurring injuries of the musculoskeletal system. A highly physiological process, fracture healing has been studied extensively. Data from in vivo, in vitro, and clinical studies have shown exposure to pulsed electromagnetic fields (PEMFs) to be influential in the fracture repair process. It has been a challenge to determine which PEMF exposure parameters (i.e., frequency of field, intensity of field, and exposure duration) will produce the most effective repair, due to the complexity of the repair process, involving many components acting at different time steps, and the variation in patient biology and physiology. Conclusively determining such parameters requires: ensuring the exposure being produced is consistent and homogeneous through field simulations and development of a device adequate to produce such a field, and: validating the exposure and its effects through cellular experimentations and computational modelling. In this PhD project, these tools were applied, first through the design and development of a device which was then subsequently used for the testing of field effects on stem cells in vitro, and then through the development of a novel wearable therapeutic prototype to be used in clinical studies for accelerated fracture repair-related processes. Through the application of such tools, an optimal exposure condition was found that significantly, above others, influenced the proliferation of stem cells. A major finding of this research was that fracture repair studies performed in vitro have limitations and as such it is recommended that more research be performed into the mechanisms of action of PEMF effects; similar experiments as those applied herein be performed at the in vivo scale; and further more anatomically similar (i.e., 3D) computational models be built stemming from those developed in this project.