Dynamizations and Exchanges

Litrenta, Jody; Tornetta, Paul; Vallier, Heather A.; Firoozabadi, Reza; Leighton, Ross; Egol, Kenneth A.; Kruppa, Christiane; Jones, Clifford B.; Collinge, Cory; Bhandari, Mohit; Schemitsch, Emil H.; Sanders, David; Mullis, Brian

doi:10.1097/bot.0000000000000311

Cited by 48 publications

(26 citation statements)

References 12 publications

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“…Confounders like gender, BMI, and hypertension had insignificant effect on efficacy of dynamization with p-values 0.760, 0.070, and 0.204 respectively. Similar findings have been reported by Litrenta 19 .…”

Section: Discussionsupporting

confidence: 92%

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

Ali¹,

Sajjad²,

Hussain³

et al. 2022

AJSMU

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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.

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Section: Discussionsupporting

confidence: 92%

“…This process has a number of benefits like increased contact area at the fracture site, better osteogenesis, and enhanced transmission of forces around weight-bearing areas. All this result in faster and better fracture healing [10][11][12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

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

Ali¹,

Sajjad²,

Hussain³

et al. 2022

AJSMU

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“…Open bone grafting with plating has yielded high rates of union [8, 9], but plating is an extensive surgical intervention. Exchange intramedullary (IM) nailing has been the mainstay of treatment for diaphyseal nonunion in the femur and tibia with success rates ranging from 53 to 100% [10, 11] and 72 to 92% [12], respectively. Part of the range in union outcomes may be due to poor bone contact at the nonunion docking site [12].…”

Section: Introductionmentioning

confidence: 99%

“…Exchange intramedullary (IM) nailing has been the mainstay of treatment for diaphyseal nonunion in the femur and tibia with success rates ranging from 53 to 100% [10, 11] and 72 to 92% [12], respectively. Part of the range in union outcomes may be due to poor bone contact at the nonunion docking site [12]. The value of compression in the biomechanics of osteogenesis has been long recognized [13, 14].…”

Section: Introductionmentioning

confidence: 99%

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Fragomen

Wellman

Rozbruch

2019

Arch Orthop Trauma Surg

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IntroductionThe magnetic intramedullary (IM) compression nail is capable of providing sustained compression for the treatment of nonunions of long bones. This ability was previously only possible with the use of external fixation. We asked the following questions: How effective is the IM compression nail at achieving union? How do we know when adequate compression has been attained? Which types of nonunions are good candidates for this treatment?Materials and methodsFourteen patients with nonunions of the tibia (5) or femur (9) were treated with the PRECICE IM compression nail. The average age was 49 years number of previous surgeries was 1.9, 7 were atrophic and 7 normotrophic, 3 were metaphyseal and 11 diaphyseal. All PRECICE IM nails were pre-distracted prior to implantation. Compression was applied post-operatively until the locking bolts were seen on X-ray to be bending or the nail was no longer shortening despite applying the external magnet.ResultsUnion was achieved in 13/14 cases. The time to union was 24.5 weeks (range 11–60). The two proximal tibia metaphyseal nonunions, both deformed into varus (4°) and flexion (10°) after compression was applied with one failing to unite. The distal tibia metaphyseal and diaphyseal nonunions did not deform upon compression. Three patients had positive cultures and were treated with IV antibiotics for 6 weeks followed by 3 months of oral suppression without subsequent infection. No mechanical nail failures were seen.ConclusionsThe IM compression nail was successful at applying compression, preventing deformity, and obtaining union in all diaphyseal and in distal tibia metaphyseal nonunions. Signs of active compression are bending of the locking bolts and failure of the nail to shorten. Proximal tibia metaphyseal nonunion may not be suited for this treatment.

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“…48,49 Micromotion at the fracture site by flexible fixation, dynamization, or weight bearing is effective in stimulating fracture healing even in patients who are smokers and those with diabetes. 48,50,51 Fundamentally, mechanical loading enhances bone formation even in diabetics and smokers and thus optimal load-sharing has the potential to improve fusion outcomes for difficult to treat populations. 52–54…”

Section: Discussionmentioning

confidence: 99%

Load-sharing through elastic micro-motion accelerates bone formation and interbody fusion

Ledet

Sanders²,

DiRisio

et al. 2018

The Spine Journal

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Dynamizations and Exchanges

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 48 publications

References 12 publications

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

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

The PRECICE magnetic IM compression nail for long bone nonunions: a preliminary report

Load-sharing through elastic micro-motion accelerates bone formation and interbody fusion

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