Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

Abstract

AIMTo analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and non-union femur fractures.METHODSUltimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. The following key words were inputted in different combinations in order to search the field of publications in its entirety: “non-union”, “delayed union”, “ununited”, “femur fracture”, “femoral fracture”, “exchange nailing”, “dynaiz(s)ation”, “secondary nailing”, “dynamic”, “static”, and “nail revision”. The initial search yielded over 150 results, and was refined based on the inclusion criteria: Only studies reporting on humans, non-unions and delayed unions, and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing. The resulting 66 articles were obtained through online journal access. The results were filtered further based on the exclusion criteria: No articles that failed to report overall union rates, differentiate between success rates of their reported techniques, or articles that analyzed less than 5 patients.RESULTSExchange nailing lead to fracture union in 84.785% of patients compared to the 66.412% of dynamization with statistically comparable durations until union (5.193 ± 2.310 mo and 4.769 ± 1.986 mo respectively). Dynamically locking exchange nails resulted in an average union time of 5.208 ± 2.475 mo compared to 5.149 ± 2.366 mo (P = 0.8682) in statically locked exchange nails. The overall union rate of the two procedures, statically and dynamically locked exchange nailing yielded union rates of 84.259% and 82.381% respectively. Therefore, there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P < 0.05. The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate (491/567 EN, 24/57 dynam, P < 0.0001). However, there was no significant difference between the success rates of the two procedures for delayed union fractures (25/27 EN, 45/55 dynam, P = 0.3299). Nevertheless, dynamization was more efficient in the treatment of delayed unions (at rates comparable to exchange nailing) than in the treatment of non-unions.CONCLUSIONIn conclusion, after examination of factors, dynamization is recommended treatment of delayed femur fractures, while exchange nailing is the treatment of choice for non-unions.

Is Nail Dynamization Useful In Delayed Union of Tibial Shaft Fractures? A Systematic Review and Meta-Analysis

“…On the other hand, we were able to observe that static screw removal is described as a simple and non-demanding surgical technique, with low morbidity rates, and less costly than other strategies, like nail exchange [36].…”

Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review

“…To confirm this, persistent NU rates after EN ranging from 11.1% to 46% have been reported in the literature [ 21 , 43 , 44 ]. In a recent systematic review, Vaughn et al showed a wide range of union rates for this technique (from 28.6% to 100%) [ 45 ].…”

Addition of shock wave therapy to nail dynamization increases the chance of long-bone non-union healing

“…Furthermore, in vivo data on sheep and dogs with comminuted tibia fractures or unstable osteotomies did not demonstrate a beneficial effect of dynamization during normal fracture healing [29][30][31]. Subsequently, nail dynamization has become a specific procedure for use in cases of non-union, although the literature shows great variation in union rates [6,32]. Vaughn et al analysed 35 patients with dynamization of femoral and tibial non-unions.…”

“…It is an economical and technically simple procedure for the treatment of long-bone non-unions. However, clinical studies are yet to prove a beneficial effect [6]; reported union rates range between 30 and 90%, and clinical studies are difficult to compare [7][8][9][10][11][12]. Factors affecting treatment success include time since fracture and the callus-to-diaphysis ratio [13,14].…”

“…Factors affecting treatment success include time since fracture and the callus-to-diaphysis ratio [ 13 , 14 ]. Meta-analyses and systematic reviews are scarce [ 6 ].…”