Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2018; 9(7): 92-99
Published online Jul 18, 2018. doi: 10.5312/wjo.v9.i7.92
Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures
Jacob E Vaughn, Ronit V Shah, Tarek Samman, Jacob Stirton, Jiayong Liu, Nabil A Ebraheim
Jacob E Vaughn, Ronit V Shah, Tarek Samman, College of Medicine and Life Sciences, University of Toledo, Toledo, OH 43614, United States
Jacob Stirton, Jiayong Liu, Nabil A Ebraheim, Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH 43614, United States
Author contributions: Vaughn JE, Shah RV and Samman T performed the research and analyzed the data and wrote the paper; Stirton J, Liu J and Ebraheim NA provided structure for the article as well as edited and revised the paper.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Jiayong Liu, MD, Assistant Professor, Department of Orthopedic Surgery, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614, United States.
Telephone: +1-800-5865336 Fax: +1-419-3835362
Received: February 3, 2018
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
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

Exchange nailing is the procedure of choice between the two in the treatment of femoral non-unions due to its significantly higher success rate.

Research perspectives

Clinical randomized controlled studies on this topic will help further elucidate this conclusion.