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International Orthopaedics

, Volume 43, Issue 1, pp 217–222 | Cite as

The ideal timing for nail dynamization in femoral shaft delayed union and non-union

  • Giovanni Vicenti
  • Davide Bizzoca
  • Massimiliano Carrozzo
  • Vittorio Nappi
  • Francesco Rifino
  • Giuseppe Solarino
  • Biagio Moretti
Original Paper

Abstract

Introduction

Nail dynamization is one of the proposed surgical options to manage femoral shaft non-union. This study aims to assess the efficacy and the ideal timing for dynamization in patients with femoral shaft delayed union or non-union.

Material and methods

Sixty-eight patients (38 male and 30 female, mean age 36.85 years old, range 22–58) were recruited. The patients were divided into three groups according to the fracture healing time: groupa A, fracture healing occurred within nine months; group B, fracture healing occurred between nine and 12 months; and group C, fracture healing after 12 months or secondary procedure needed for union. Callus-to-diaphysis ratio was calculated on femur X-rays at the time of dynamization.

Results

In 30 patients out of 68, the fracture healing was observed at nine month follow-up; in 26 patients, the fracture healed within 12 months; eight fractures healed in more than 12 months and only four fractures required a secondary procedure for union. Dynamization was successful in 64 patients out of 68 (94.12%). The mean callus-diaphysis ratio was significantly different in group A (p = 0.001) and in group B (p = 0.03), compared with group C. The timing of dynamization resulted significantly different between the three groups. Linear regression analysis revealed that nail dynamization should be performed between three and six months after trauma. The optimal callus-to-diaphysis ratio should be comprised between 1.47 and 1.19, at the time of dynamization.

Discussion

Nail dynamization revealed safe and effective in the treatment of femoral delayed union and non-union. It should be considered as a first-line treatment for femoral non-union or delayed union.

Keywords

Femoral non-union Femoral delayed union Nail dynamization Femoral shaft fractures 

Notes

Compliance with ethical standard

This study was conducted in accordance with the declaration of Helsinki. Informed consent was obtained from all participants.

Conflict of interest

The authors declare that there are no conflicts of interest.

References

  1. 1.
    Arneson TJ, Melton LJ, Lewallen DG, O’Fallon WM (1988) Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin Orthop Relat Res:188–194Google Scholar
  2. 2.
    Salminen ST, Pihlajamäki HK, Avikainen VJ, Böstman OM (2000) Population based epidemiologic and morphologic study of femoral shaft fractures. Clin Orthop Relat Res:241–249Google Scholar
  3. 3.
    Vermesan D, Prejbeanu R, Haragus H et al (2017) Case series of patients with pathological dyaphiseal fractures from metastatic bone disease. Int Orthop 41:2199–2203.  https://doi.org/10.1007/s00264-017-3582-3 CrossRefGoogle Scholar
  4. 4.
    Lee JR, Kim H-J, Lee K-B (2016) Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing. Orthop Traumatol Surg Res 102:175–181.  https://doi.org/10.1016/j.otsr.2015.11.014 CrossRefGoogle Scholar
  5. 5.
    Pihlajamäki HK, Salminen ST, Böstman OM (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 16:394–402CrossRefGoogle Scholar
  6. 6.
    Chen W, Jing Y, Lv H et al (2016) Displaced femoral shaft fractures treated by antegrade nailing with the assistance of an intramedullary reduction device. Int Orthop 40:1735–1739.  https://doi.org/10.1007/s00264-015-3036-8 CrossRefGoogle Scholar
  7. 7.
    Somford MP, van den Bekerom MPJ, Kloen P (2013) Operative treatment for femoral shaft nonunions, a systematic review of the literature. Strategies Trauma Limb Reconstr 8:77–88.  https://doi.org/10.1007/s11751-013-0168-5 CrossRefGoogle Scholar
  8. 8.
    Lynch JR, Taitsman LA, Barei DP, Nork SE (2008) Femoral nonunion: risk factors and treatment options. J Am Acad Orthop Surg 16:88–97CrossRefGoogle Scholar
  9. 9.
    Koso RE, Terhoeve C, Steen RG, Zura R (2018) Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop.  https://doi.org/10.1007/s00264-018-3864-4
  10. 10.
    Vaughn J, Gotha H, Cohen E et al (2016) Nail dynamization for delayed union and nonunion in femur and tibia fractures. Orthopedics.  https://doi.org/10.3928/01477447-20160819-01
  11. 11.
    Gelalis ID, Politis AN, Arnaoutoglou CM et al (2012) Diagnostic and treatment modalities in nonunions of the femoral shaft. A review. Injury 43:980–988.  https://doi.org/10.1016/j.injury.2011.06.030 CrossRefGoogle Scholar
  12. 12.
    Huang K-C, Tong K-M, Lin Y-M et al (2012) Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury 43:1747–1752.  https://doi.org/10.1016/j.injury.2012.06.024 CrossRefGoogle Scholar
  13. 13.
    Tigani D, Fravisini M, Stagni C et al (2005) Interlocking nail for femoral shaft fractures: is dynamization always necessary? Int Orthop 29:101–104.  https://doi.org/10.1007/s00264-004-0627-1 CrossRefGoogle Scholar
  14. 14.
    Wu CC (1997) The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma 43:263–267CrossRefGoogle Scholar
  15. 15.
    Wu CC, Shih CH (1993) Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg 36:302–306Google Scholar
  16. 16.
    Wu C-C, Chen W-J (1997) Healing of 56 segmental femoral shaft fractures after locked nailing: poor results of dynamization. Acta Orthop Scand 68:537–540.  https://doi.org/10.3109/17453679708999022 CrossRefGoogle Scholar
  17. 17.
    Johnson KD, Johnston DW, Parker B (1984) Comminuted femoral-shaft fractures: treatment by roller traction, cerclage wires and an intramedullary nail, or an interlocking intramedullary nail. J Bone Joint Surg Am 66:1222–1235CrossRefGoogle Scholar
  18. 18.
    Akram Saji MA, Rabari YB, Kumar Gupta R et al (2017) Comparative study of static versus dynamic intramedullary nailing of tibia. Int J Orthop Sci 3:283–286.  https://doi.org/10.22271/ortho.2017.v3.i3e.52 CrossRefGoogle Scholar
  19. 19.
    Yokota H, Tanaka SM (2005) Osteogenic potentials with joint-loading modality. J Bone Miner Metab 23:302–308.  https://doi.org/10.1007/s00774-005-0603-x CrossRefGoogle Scholar
  20. 20.
    Vécsei V, Häupl J (1989) The value of dynamic adjustment in locking intramedullary nailing. Aktuelle Traumatol 19:162–168Google Scholar
  21. 21.
    Rupp M, Biehl C, Budak M et al (2018) Diaphyseal long bone nonunions — types, aetiology, economics, and treatment recommendations. Int Orthop 42:247–258.  https://doi.org/10.1007/s00264-017-3734-5 CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.School of Medicine, AOU Consorziale Policlinico, Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma UnitUniversity of Bari Aldo MoroBariItaly

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