High rate of union possible with dynamization, exchange nailing of tibia fractures

NEW ORLEANS – Researchers found a high rate of union for both dynamization and exchange nailing procedures in the treatment of patients with tibia fractures, according to a study presented at the American Academy of Orthopaedic Surgeons Annual Meeting.

“Both dynamization and exchange nailing have high success rates regardless of the fracture type or the fracture location. However, the presence of a fracture gap does increase the failure rate of both procedures,” Jody Litrenta, MD, said, here.

In the retrospective multicenter study, Litrenta and colleagues studied the records and radiographs of 194 patients with tibia fractures who had dynamization or exchange nailing for delayed or nonunion fractures, which was defined as at least 3 postoperative months with no progression of healing. They recorded demographic data, fracture type, cortical contact/gap greater than 5 mm, timing and success rates of the secondary intervention, and RUST [radiographic union score for tibia fracture] scores at intervention and follow-up.

The researchers defined success as union and failure as nonunion or patients who needed additional intervention.

Overall, 88 patients with tibia fractures underwent dynamization and 91 patients had exchange nailing. The average age was 39 years with more men enrolled in the study. There were 119 open (48% grade III) and 71 closed fractures in the proximal, midshaft or distal tibia. Researchers found no statistical differences between the groups in terms of demographics or fracture characteristics, although a gap or bone defect was more commonly seen in the exchange group.

Overall, 83% of dynamizations united at a median 11.1 months, and 90% of patients who had exchanges united at a median of 13.4 months. For the dynamization group, RUST scores at union were 10.2 and they were 10.4 for patients in the exchange group. There were 24 reoperations. The success rate was not different for patients who had exchange nails or dynamizations performed early vs. patients who had it performed after 6 months. They also found that having no cortical contact or gap was a statistically negative factor for patients in both groups. The successful union rate when a gap was present was 78% vs. 92% when no gap was absent.

“Individual success or failure of either technique did not differ by fracture location or open or closed fracture,” she said.

Reference:

Litrenta J. Paper #78. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

Disclosure: Litrenta has no relevant financial disclosures.