Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

• 作者: Jacob E Vaughn Jacob Stirton Jiayong Liu Nabil A Ebraheim Ronit V Shah Tarek Samman
• 来源期刊: 世界骨科杂志
• 学科: 医学
• 关键词: NON-UNION DELAYED UNION Dynamization FEMORAL fracture EXCHANGE NAILING
• 年，卷（期）: 2018,（7）
• 页码范围: 92-99
• 页数: 8页
• 分类号: R

摘要

AIM To analyze the literature on efficacy of dynamamization vs exchange nailing in treatment of delayed and nonunion femur fractures.METHODS Ultimately,31 peer-reviewed articles with 644 exchanged nailing patients and 131 dynamization patients were identified and analyzed.The following key words were inputted in different combinations in order to search the field of publications in its entirety:“nonunion”,“delayed union”,“ununited”,“femur fracture”,“femoral fracture”,“exchange nailing”,“dynaiz(s)ation”,“secondary nailing”,“dynamic”,“static”,and“nail revision”.The initial search yielded over 150 results,and was refined based on the inclusion criteria:Only studies reporting on humans,non-unions and delayed unions,and the usage of exchange nailing and/or dynamization as a secondary treatment after failed IM nailing.The resulting 66 articles were obtained through online journal access.The results were filtered further based on the exclusion criteria:No articles that failed to report overall union rates,differentiate between success rates of their reported techniques,or articles that analyzed less than 5 patients.RESULTS Exchange nailing lead to fracture union in 84.785%of patients compared to the 66.412%of dynamization with statistically comparable durations until union(5.193±2.310 mo and 4.769±1.986 mo respectively).Dynamically locking exchange nails resulted in an average union time of 5.208±2.475 mo compared to 5.149±2.366 mo(P=0.8682)in statically locked exchange nails.The overall union rate of the two procedures,statically and dynamically locked exchange nailing yielded union rates of 84.259%and 82.381%respectively.Therefore,there was no significant difference between the different locking methods of exchange nailing for union rate or time to union at a significance value of P<0.05.The analysis showed exchange nailing to be the more successful choice in the treatment of femoral non-unions in respect to its higher success rate(491/567 EN,24/57 dynam,P<0.0001).Howeve