Effects of Dynamization on Delayed Union of Tibial Shaft Fractures After Reamed Intramedullary Interlocked Nailing

Abstract

Objective: To determine the efficacy of dynamization in delayed union of tibia diaphyseal fractures Methodology: A descriptive cross sectional study was done at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from July 2020 to April 2021. A total of 97 consenting patients who suffered from delayed union following intramedullary interlocking nailing were included in the study. Dynamization involved removal of proximal or distal locking screws in statically locked intramedullary nail. Patients were followed up for six months to check for delayed bone union. All the collected data were entered into a pro forma and used electronically for research purpose. Results: Over all union was achieved in 72 (74.2%) cases after dynamization. The mean age of our study population was 39.42+13.79 years. Advanced age, smoking, fresh or old fracture, the time of initial intramedullary nailing, and diabetes were associated with decreased efficacy of dynamization, with p-value <0.001, 0.033, 0.007, and <0.001 respectively. While no significant association was found between gender, BMI, hypertension, and union (p-value >0.05). Conclusion: The findings of this study support the idea that dynamization can be an effective method to promote healing in tibia diaphyseal fractures for delayed union. More randomized comparative clinical trials are necessary to evaluate the effectiveness of dynamization.

Delayed Union and Nonunion: Current Concepts, Prevention, and Correction: A Review

“…As with prophylactic dynamization, nail dynamization procedures carry risks of excessive motion at the fracture site, resulting in fixation failure, fracture shortening, and/or refracture [ 4 , 101 ]. Modern advances in nail dynamization have centered around supplementary therapies such as shock wave to improve bone healing following the dynamization procedure, but recent clinical studies have confirmed the value of nail dynamization as an early intervention for delayed bone healing, reporting improved success rates of 75–85% in tibial and femoral fracture cases [ 102 , 103 , 104 ].…”