The treatment of delayed union of bone fractures has served for the past 20 years as the principal testing ground for determining whether nonionizing electromagnetic fields can have any substantial, long-term effects in clinical medicine. Recent double-blinded clinical trials have confirmed the significance of the reported effects on bone healing and have led to the suggestion that electromagnetic fields may also be useful in the treatment of other orthopedic problems such as fresh fractures, stabilization of prosthetic implants, or even the prevention or treatment of osteoporosis. However, the design of appropriate treatment regimens for these new applications would be greatly facilitated if it were understood how the biological cells within bone tissue sense these low-frequency, and remarkably low level, electromagnetic fields. Here we address the engineering and physical science aspects of this problem. We review the characteristics of clinically used electromagnetic fields and discuss which components of these fields may actually be responsible for altering the activity of the bone cells. We then consider several physical mechanisms which have been proposed to explain how the cells within the bone or fracture tissue detect this field component.
