DEFERRED DYNAMIZATION FOR NONUNION OF FEMORAL SHAFT FRACTURES AFTER STATIC INTERLOCKING NAIL_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PANLinhua ,  WANGJinping , LIAOYing

Department of Trauma Orthopedics, the First Affiliated Hospital of Nanhua University, Hengyang Hunan, 421001, P. R. China;

Corresponding?author：

WANGJinping, Email: jpwpzhh@163.com

Keywords：

Femoral shaft fracture; Nonunion; Interlocking nail; Dynamization

DOI：

10.7507/1002-1892.20140095

Video：

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Objective To investigate the effectiveness and indications of deferred dynamization for nonunion of femoral shaft fractures after static interlocking nail. Methods Between March 2006 and June 2012, 26 patients with nonunion of femoral shaft fractures after static interlocking nail were treated with deferred dynamization, and their data were analyzed retrospectively. There were 19 males and 7 females with a mean age of 38 years (range, 22-46 years). Nonunion was found at 10-29 months (mean, 16 months) after open reduction and static interlocking nail for fracture fixation. Referring to Papakostidis criteria for nonunion, there were 7 cases of stable/hyperplastic type, 3 cases of stable/atrophic type, 12 cases of unstable/hyperplastic type, and 4 cases of unstable/atrophic type. Results All incision healed at first stage. Twenty-six patients were followed up 10-28 months (mean, 14 months). A total of 16 (61.5%) fractures healed at 4-11 months after deferred dynamization (7 cases of stable/hyperplastic type and 9 cases of unstable/hyperplastic type); the other 10 fractures failed to heal. The healing rate was 100% (7/7) in patients with stable/hyperplastic type nonunion, 75% (9/12) in patients with unstable/hyperplastic type nonunion, and 0 in patients with stable/atrophic type and unstable/atrophic type nonunion. Conclusion Deferred dynamization is an effective method for hyperplastic nonunion of femoral shaft fractures after static interlocking nail, but it is not suitable for atrophic nonunion of femoral shaft fractures.

Citation： PANLinhua, WANGJinping, LIAOYing. DEFERRED DYNAMIZATION FOR NONUNION OF FEMORAL SHAFT FRACTURES AFTER STATIC INTERLOCKING NAIL. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 419-422. doi: 10.7507/1002-1892.20140095 Copy

1.	汪金平, 向生健, 鐘鳳林, 等. 閉合復位帶鎖髓內釘固定治療股骨干粉碎性骨折. 中國修復重建外科雜志, 2007, 21(9):1017-1019.
2.	王紅川, 樓華, 蔣俊威, 等. 閉合復位交鎖髓內釘內固定治療股骨干骨折. 中國修復重建外科雜志, 2008, 22(6):700-702.
3.	Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2):89-94.
4.	程堅, 符培亮, 陶波. 交鎖髓內釘動力化治療股骨干骨折不愈合. 中國修復重建外科雜志, 2013, 27(1):131-132.
5.	Richmond J, Colleran K, Borens O, et al. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma, 2004, 18(9):603-610.
6.	Huang KC, Tong KM, Lin YM, et al. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury, 2012, 43(10):1747-1752.
7.	Papakostidis C, Psyllakis I, Vardakas D, et al. Femoral-shaft fractures and nonunions treated with intramedullary nails:the role of dynamisation. Injury, 2011, 42(11):1353-1361.
8.	Stucken C, Olszewski DC, Creevy WR, et al. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg (Am), 2013, 95(15):1409-1412.
9.	Bhandari M, Fong K, Sprague S, et al. Variability in the definition and perceived causes of delayed unions and nonunions:a cross-sectional, multinational survey of orthopaedic surgeons. J Bone Joint Surg (Am), 2012, 94(15):e1091-1096.
10.	Runkel M, Rommens PM. Pseudoarthrosis. Unfallchirurg, 2000, 103(1):51-63.
11.	秦煜. 骨折愈合、延遲愈合和骨不連. 中華創傷骨科雜志, 2004, 6(9):1059-1062.
12.	賈金生, 范步新, 劉書茂, 等. 股骨干骨折帶鎖髓內釘固定術后骨折不愈合臨床原因分析. 生物骨科材料與臨床研究, 2012, 9(5):42-45.
13.	劉璠, 祁俊. 骨折不愈合與延遲愈合的成因與治療. 中華創傷骨科雜志, 2005, 7(5):405-408.
14.	張長青, 張開剛, 蘇琰, 等. 股骨、脛骨骨折交鎖髓內釘固定后骨不連的診治. 中華創傷骨科雜志, 2006, 8(1):38-40.
15.	屈振寧, 李紅哲. 脛骨骨折內固定術后隱性感染致骨折不愈合. 中國實用醫藥, 2011, 6(1):102-103.
16.	Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of the femoral diaphysis, the influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg (Br), 2000, 82(5):655-658.
17.	Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft:a review. Injury, 2012, 43(7):980-988.
18.	Papakostidis C, Psyllakis I, Vardakas D, et al. Femoral-shaft fractures and nonunions treated with intramedullary nails:the role of dynamisation. Injury, 2011, 42(11):1353-1361.
19.	Wu CC, Chen WJ. Healing of 56 segmental femoral shaft fractures after locked nailing, poor results of dynamization. Acta Orthop Scand, 1997, 68(6):537-540.
20.	Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma, 1997, 43(2):263-267.

1. 汪金平, 向生健, 鐘鳳林, 等. 閉合復位帶鎖髓內釘固定治療股骨干粉碎性骨折. 中國修復重建外科雜志, 2007, 21(9):1017-1019.
2. 王紅川, 樓華, 蔣俊威, 等. 閉合復位交鎖髓內釘內固定治療股骨干骨折. 中國修復重建外科雜志, 2008, 22(6):700-702.
3. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2):89-94.
4. 程堅, 符培亮, 陶波. 交鎖髓內釘動力化治療股骨干骨折不愈合. 中國修復重建外科雜志, 2013, 27(1):131-132.
5. Richmond J, Colleran K, Borens O, et al. Nonunions of the distal tibia treated by reamed intramedullary nailing. J Orthop Trauma, 2004, 18(9):603-610.
6. Huang KC, Tong KM, Lin YM, et al. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury, 2012, 43(10):1747-1752.
7. Papakostidis C, Psyllakis I, Vardakas D, et al. Femoral-shaft fractures and nonunions treated with intramedullary nails:the role of dynamisation. Injury, 2011, 42(11):1353-1361.
8. Stucken C, Olszewski DC, Creevy WR, et al. Preoperative diagnosis of infection in patients with nonunions. J Bone Joint Surg (Am), 2013, 95(15):1409-1412.
9. Bhandari M, Fong K, Sprague S, et al. Variability in the definition and perceived causes of delayed unions and nonunions:a cross-sectional, multinational survey of orthopaedic surgeons. J Bone Joint Surg (Am), 2012, 94(15):e1091-1096.
10. Runkel M, Rommens PM. Pseudoarthrosis. Unfallchirurg, 2000, 103(1):51-63.
11. 秦煜. 骨折愈合、延遲愈合和骨不連. 中華創傷骨科雜志, 2004, 6(9):1059-1062.
12. 賈金生, 范步新, 劉書茂, 等. 股骨干骨折帶鎖髓內釘固定術后骨折不愈合臨床原因分析. 生物骨科材料與臨床研究, 2012, 9(5):42-45.
13. 劉璠, 祁俊. 骨折不愈合與延遲愈合的成因與治療. 中華創傷骨科雜志, 2005, 7(5):405-408.
14. 張長青, 張開剛, 蘇琰, 等. 股骨、脛骨骨折交鎖髓內釘固定后骨不連的診治. 中華創傷骨科雜志, 2006, 8(1):38-40.
15. 屈振寧, 李紅哲. 脛骨骨折內固定術后隱性感染致骨折不愈合. 中國實用醫藥, 2011, 6(1):102-103.
16. Giannoudis PV, MacDonald DA, Matthews SJ, et al. Nonunion of the femoral diaphysis, the influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg (Br), 2000, 82(5):655-658.
17. Gelalis ID, Politis AN, Arnaoutoglou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft:a review. Injury, 2012, 43(7):980-988.
18. Papakostidis C, Psyllakis I, Vardakas D, et al. Femoral-shaft fractures and nonunions treated with intramedullary nails:the role of dynamisation. Injury, 2011, 42(11):1353-1361.
19. Wu CC, Chen WJ. Healing of 56 segmental femoral shaft fractures after locked nailing, poor results of dynamization. Acta Orthop Scand, 1997, 68(6):537-540.
20. Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma, 1997, 43(2):263-267.

Chinese Journal of Reparative and Reconstructive Surgery

DEFERRED DYNAMIZATION FOR NONUNION OF FEMORAL SHAFT FRACTURES AFTER STATIC INTERLOCKING NAIL

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