Nail Dynamization for Delayed Union and Nonunion in Femur and Tibia Fractures

Abstract

Femoral and tibial shaft fractures are common injuries in the United States. Since their introduction, reamed intramedullary nails have become the treatment of choice for most of these fractures. However, delayed union and nonunion can complicate treatment in up to 10% of patients. Removal of interlocking screws, or dynamization, can promote fracture healing in cases of delayed union or nonunion. The efficacy of nail dynamization has been reported to range from 19% to 82%. This study was conducted to evaluate the efficacy of dynamization, identify the factors associated with its success or failure, and analyze the cost compared with exchange nailing. The authors retrospectively reviewed charts from 2011 to 2014 and searched billing records for Current Procedural Terminology codes 27506 and 27759, for intramedullary nailing of femoral and tibial shaft fractures, and code 20680, for removal of deep hardware. This search identified 34 patients with 35 fractures treated with dynamization for delayed union or nonunion. Dynamization was effective in creating union in 54% of patients. The factor that best correlated with the success of dynamization was the diameter of the fracture callus at the time of dynamization. Direct costs associated with dynamization were nearly $10,000 less than those associated with exchange nailing. Dynamization can be an effective first-line treatment for delayed union and nonunion of femoral and tibial shaft fractures. The union rate in the current study is similar to previously published rates, and cost data suggest that dynamization is a viable alternative to exchange nailing for some patients with delayed union or nonunion. [Orthopedics. 2016; 39(6):e1117-e1123.].

Incomplete Eradication of Persistent Infection May Impede Union: Our Experience in Treating Fracture Non-Unions with Allogenic MSC

“…Dynamization may promote fracture healing and can be proposed as the primary treatment in non-union cases. 6,38,39 However, it should be taken into consideration that the use of intramedullary reaming and nailing, in particular, affects the microvasculature of the bone.…”

Dynamically locked intramedullary interlocking nail for fracture shaft of tibia: An effective surgical protocol with minimal complications

“…Although the treatment algorithm differs in each case, nail dynamization can be a quick, cost-saving, and effective method to promote healing. 7 In our study of 90 patients with fracture shaft of tibia we used tibia IMIL we used only a dynamic proximal locking bolt with an early weight bearing mobilization. This protocol of ours gave an excellent result with a 100% union at an average of 16 wks.…”

“…There were many studies which supported the use of dynamic IMIL nail in tibial shaft fractures. [8][9][10][11] Josh Vaughn et al 10 showed a faster union in dynamic group than the static group, wherein an additional dynamisation procedure was needed in few cases to achieve union. Hernández-Vaquero D et al, also showed similar results of better union with dynamization, but their results did not show statistical significance.…”

İntrameduller çivi uygulamasında erken yük vermenin kırık kaynamasına etkisi

“…Tibia cisim kırklarında kaynamama ya da gecikmiş kaynama halen daha bir sorun olarak karşımıza çıkmaktadır [7,8]. Kaynamama da ilk önerilen yöntem çivi değişimidir [9].…”