Journal of Musculoskeletal Trauma

The Efficacy of Dynamization of Static Interlocking Intramedullary Nailing as A Trial Leading to Bony Union of Femur Shaft Fracture: Byung Soon Kim, Duck Yeon Cho, Hyung Ku Yoon, Soo Hong Han, Jin Yong Kim, Yong Wook Kim; J Korean Soc Fract 2002;15(2):138-145. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.138

Abstract PDF: PURPOSE
To evaluate the efficacy of dynamization of static interlocking intramedullary nailing as a trial leading to bony union of femur shaft fracture, delayed union of femur shaft fracture underwent dynamization were investigated. MATERIALS & METHODS: Between april 1995 and December 2000, 162 patients were treated static interlocking intramedullary nailing, 14 patients were selected who had underwent dynamization. The average age was 39 years old (range 24 to 61), they were 11 men and 3 women. The type of fractures were two communited, seven segmental and five simple fractures. Dynamization were done by removal of proximal or distal interlocking screw. We defined complete bony union as radiological and clinical bony union. Also we measured leg length discrepancy and angulation by radiologic parameters.
RESULTS
Of the 14 patients who showed delayed union, 7 patients were noted successful bony union by dynamization, and of the 7 patients who failed union by dynamization, 6 patients were noted bony union by supportive operative treatments(bone graft : 4 patients, nail exchanging : 1 patient, both method 1 patient). One patient was seen nonunion state because of patient's refusal of treatment. 7 patients who were noted successful bony union by dynamization had 2 degrees~6 degrees(average 4.14 degrees) varus-valgus angulation and 4 degrees~9 degrees(average 6 degrees) AP angulation, and 3 of the 7 patients showed leg length discrepancy(LLD) greater than 2 cm. The other 7 patients had 2 degrees~5 degrees(average 3.57 degrees) varus-valgus angulation and 3 degrees~7 degrees(average 5 degrees) AP angulation, and 2 of the 7 patients showed LLD greater than 2cm. Of the 14 patients, 5 patients showed limping.
CONCLUSION
Dynamization of intramedullary nainling is a simple and valuable method for improving bony union of femur shaft fracture in the case of delayed union. But if the delayed unions are seen due to large bone defect, supportive operative treatments (bone graft, nail exchanging etc.) to avoid significant complica-tion(shortening and angulation) is needed.

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The Effect of Dynamization in Tibia Fracture: Jin Woo Kwon, Seung Ho Shin, Won Ho Cho, Woo Se Lee, Ki Ho Sung; J Korean Soc Fract 2001;14(1):52-59. Published online January 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.1.52

Abstract PDF: PURPOSE
The purpose of this study is to evaluate the effect of dynamization which was done for the treatment of delayed union or persisting fracture gap after interlocking intramedullary nailing, by radiographic and physical examination.
MATERIALS AND METHODS
We analyzed 22 cases these were treated with dynamization from 247 cases of tibia shaft fracture treated initially with static interlocking intramedullary nailing from February l990 to May 2000 and were followed up more than lyear. The result of dynamization was classified as 3 groups and we divided each results 3 categories that is effective result, uncertain result and ineffective result. Group A is cases that achived ultimate union with shortening of fracture gap and was 10 cases. Group B is that achieved ultimate union but fracture gap did not reduced and was 10 cases. Group C is that showed ultimate non-union and was 2 cases.
RESULTS
The result is that dynamization was effective only 4 cases of group A. 6 cases of group A and 4 cases of group B showed instability(radiolucent halo around nail, hypertrophied callus and leg pain), and 6 cases of group B showed no shortening of fracture gap, thus these were classified as uncertain result. Group C(2 cases) showed non-union, classified as ineffective.
CONCLUSION
Dynamization caused instability in most tibia fractures except simple mid-shaft fracture. So in the comminuted fractures and distal or proximal l/3 oblique fractures, other procedures such as bone graft, refixation should be considered rather than dynamization.

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Role of Dynamization in the Interlocking Nailing for Fractures of Femur: Sung Churl Lee, Suk Joo Lyu; J Korean Soc Fract 1999;12(1):35-39. Published online January 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.1.35

Interlocking screws have extended the use of intramedullary nail into comminuted, unstable fractures, from subtrochanteric to supracondylar region of the femoral fractures. But it is still controversial whether dynamization is necessary in the course of treatment. Forty-nine femoral fractures treated with interlocked intramedullary nailing were investigated. Static nailing was converted to dynamic one in 33 femurs with removal of the proximal or distal locking screws. The rest were kept in static nailing. In 19 out of 33 cases with dynamization, there was average 6.0mm of telescoping after dynamization. Average 3.8mm of telescoping was seen in 15 out of 25 cases with removal of the distal locking screws while average 14.3mm in 4 out of 8 cases with removal of the proximal locking screws. There were 4 cases of breakage of distal locking screws without dynamization. Union was achieved in 45 fractures of the 49 cases. Dynamization improves fracture healing by reducing fracture gap and increasing axial compression. Dynamization is necessary in selected cases, especially fractures with a large fracture gap after static nailing and fractures that failed in filling the fracture gap even after some time postoperatively, and it is even more necessary in order to prevent breakage of locking screws in such cases.

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“Chair”–“Boat” Conformational Transition of Cyclohexanone during the Oxidation of Cyclohexane
S. V. Puchkov, Yu. V. Nepomnyashchikh
Журнал физической химии.2023; 97(8): 1155. CrossRef
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The Journal of the Korean Shoulder and Elbow Society.2013; 16(2): 107. CrossRef

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Treatments of the delayed Union or Nonunion of Tibial Shaft Fracture Fixed with Interlocking IM nail: Yong Bum Park, chung Soo Hwang, Phil Hyun Chung, Suk Kang, Dong Joo Chae, Han Chul Kim, Sang Ho Moon, Jong Phil Kim, Dae Jin Kim; J Korean Soc Fract 1998;11(3):552-559. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.552

Abstract PDF: Interlocking intramedullary nailing has been the first choice treatment of most tibial shaft fractures because its rigidity of fixation allows early ROM and weight bearing. Although most interlocking nailing procedures are performed with closed reduction that preserve periosteal blood supply, delayed union or nonunion is often occurs. so secondary procedures, such as bone graft, dynamization, nail exchange, are necessary to achieve fracture healing. We analyzed 25 cases of delayed union or nonunion from 432 tibial shaft fractures fixed initially with static interlocking intramedullary nailing since January 1990 till January 1996. Overall incidence of delayed union or nonunion is 5.8%(25/432). Secondary procedures included mainly iliac bone graft or dynamization. Average time to achieve bone union after secondary procedure is 6.1 months. The more distracted or displaced fracture ends after interlocking nailing or the more comminuted fracture fragments led to the more delayed bone union. Careful attention to minimize distraction or displacement during interlocking nailing is necesary to decrease the incidence of delayed union or nonunion. And appropriate procedures should be performed when delayed union or nonunion is predicted, which result in success in most cases.

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The Effect of Dynamization After Static Intelocking Intramedullary Nailing: Kyoo Seog shin, Jong Soon Kim, Kong Wha Lee, Jin Hwan Seo; J Korean Soc Fract 1998;11(2):262-268. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.262

Abstract PDF: We had investigated the effect of dynamization in static interlocking intramedullary nailing for the long bone fracture of the femur and tibia treated in Bongseng Memorial Hospital for last 3 years (from Jan. 1994 to Jan. 1997) Total 62 patients (37 tibia, 28 femur) were treated, 35 cases were reamed at operaion and 27 cases not reamed. following results were obtained; 1. In all except 24 fractures, the static interlocking intramedullary nail was preserved without dynamization and got to mean union time of 17.2 weeks (femur) and 6.4 weeks (tibia). 2. The 24 patients (14 femur, 10 tibia) did not show callus formation and complained of vague pain in fracture site at 20 weeks after static mode. In those cases, we tried dynamization as a initial treatment modality. 3. The success rate after dynamization was about 87%. 4. The interval between nailing and dynamization did not affect the success rate. 5. Dynamization could be done day surgery.

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Interlocking Intramedullary Nailing with Transfixing Serew for Femur Shaft Fracture: Sung Kwan Hwang, Woo Yong Yi; J Korean Soc Fract 1992;5(2):289-299. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.289

Abstract PDF: Despite advances in fracture management. the long bone fracture have high rate of morbidity. Recently interlocking intramedullary nailing have gained increasing attention and accepta- nce as a treatment modality for femoral shaft fracture. Early proper fixation of long bone fractures is needed for early mobiliaation of the patient to facilitate pulmonary care and to prevent secondary complications due to prolonged bed rest and traction We treated twenty-eight patients of femur shaft fracture using interlocking intramedullary nails and transfixing screws. All twenty-eight fractures were nailed in static fashion initially. Twelve patients were randomly chosen and they were changed from statlc fixation to dynamic fixation at average 16 weeks after surgory. The purpose of this study was to compare the bone healing rates, clinical results, and postoperative complication between the static fixation group and dynamiaation group. The results were as follows ; 1. According to Winqulst-Hansen classification : 9 cases were type I : 7 cases, type II : 6 cases, type III : 4 cases, type IV and : 2 cases, type V. 2. All sixteen fractures, treated by static fixation achieved bony union(mean union time : 21 weeks). 3. Of twelve fractures with dynamization, eleven fractures were united (mean union time, 19 weeks). 4. Postoperative complications were limb shortening (4 cases : mean 0.7cm), nail breakage (1 case) and nonunion(1 case). We consider interlocking intramedullary nailing is the treatment of choice for closed or open femoral shaft fractures and dynamization is not an essential procedure for fracture healing.

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