Comparative study of static versus dynamic intramedullary nailing of tibia

Abstract

Introduction: Reamed intramedullary nails have become the treatment of choice for the majority of these fractures. Rates of union in both femoral and tibial shaft fractures have been reported to range from 90% to 100% with the use of intramedullary nails. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamisation include conversion of static nail by removing screws from the longest fragment. Materials & Methods: This was a retrospective case-control study of closed or type I open tibial diaphyseal fractures (types A and B according to the AO classification) treated with dynamic nailing (30 cases) or static nailing (30 cases). The type of intramedullary nail, the surgical technique and the postoperative protocol were similar for both groups, with the exception of the locking mode and the time of weight bearing. Time to union, mechanical and biological complications, and the number and type of re-operations needed until union were recorded and analysed. Results: The mean time to union was 21 weeks in the dynamic group and 26 weeks in the static group. A strong trend was seen in favour of the dynamic nailing group. (p < 0.01) statistically significant difference was observed. Sixteen out of the 60 patients (26.9%) had at least one complication Conclusions: Dynamic nailing assembly in intramedullary nailing in closed or type I open tibial diaphyseal fractures with limited comminution (types A and B according to the AO classification) is safe when used for these fracture types.