Published online Jul 18, 2018. doi: 10.5312/wjo.v9.i7.92
Peer-review started: February 6, 2018
First decision: March 2, 2018
Revised: April 24, 2018
Accepted: May 30, 2018
Article in press: May 30, 2018
Published online: July 18, 2018
Dynamization involves the removal of proximal or distal locking screws in a statically locked IM nail which allowing weight bearing to stimulate osseous growth at the fracture site.
Although rare, delayed union and non-union of fractures are major complications in the treatment of femoral fractures with intramedullary (IM) nailing. Surgeons use dynamization and exchange nailing to treat these complications and achieve osseous union.
The purpose of this study is to analyze the literature on these procedures in their treatment of delayed and non-union femur fractures to determine their efficacy and factors related to their success.
Exchange nailing consists of the removal of the current IM nail, debridement of the medullary cavity, followed by insertion of a larger IM nail. Currently there is lack updated systematic review and meta-analysis on efficacy of dynamamization vs exchange nailing in treatment of delayed and non-union femur fractures.
Ultimately, 31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed. It was found that when treating femoral non-unions, exchange nailing was shown to achieve osseous union in a higher percentage of patients than dynamization with comparable recovery times. However, dynamization appears to be equally as effective as exchange nailing in the treatment of delayed unions.
Exchange nailing is the procedure of choice between the two in the treatment of femoral non-unions due to its significantly higher success rate.
Clinical randomized controlled studies on this topic will help further elucidate this conclusion.