Department of Orthopaedic Surgery, School of Medicine, University of Oviedo, Spain.
Injury. 2012 Dec;43 Suppl 2:S63-7. doi: 10.1016/S0020-1383(13)70182-7.
To compare the safety and effect on tibial diaphyseal fracture bone union of two intramedullary nailing techniques: (1) dynamic locking with early, full weight bearing, and (2) static locking with delayed weight bearing until bone union.
This is 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 (32 cases) or static nailing (35 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.
Mean union time was 21 weeks in the dynamic group and 26 in the static group (p = 0.051). In both groups 3 cases of nonunion were noted. In the dynamic group there was 1 case of delayed union and 1 case of malunion. In the static group, 5 cases of delayed union and 5 cases of malunion were found. Four reoperations were required in the dynamic group, whereas 10 were needed in the static group (p >0.05). Initial degree of interfragmentary gaps had an impact on the mean time to union and the appearance of biological complications in both groups.
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. A dynamic mode of nailing should be encouraged in these fracture patterns.
比较两种髓内钉技术治疗胫骨骨干骨折骨愈合的安全性和效果：（1）动力锁定，早期完全负重；（2）静态锁定，延迟至骨愈合后负重。
这是一项回顾性病例对照研究，纳入闭合或 I 型开放性胫骨骨干骨折（AO 分类的 A 和 B 型）患者，分别接受动力钉（32 例）或静态钉（35 例）治疗。两组的髓内钉类型、手术技术和术后方案相似，除锁定模式和负重时间外。记录和分析愈合时间、机械和生物学并发症、以及需要再次手术以达到愈合的次数和类型。
动力组的平均愈合时间为 21 周，静态组为 26 周（p=0.051）。两组均有 3 例骨不连。动力组 1 例延迟愈合，1 例畸形愈合。静态组有 5 例延迟愈合，5 例畸形愈合。动力组需要 4 次再手术，而静态组需要 10 次（p>0.05）。两组初始断端间隙程度均对平均愈合时间和生物学并发症的发生有影响。
对于有限粉碎的闭合或 I 型开放性胫骨骨干骨折（AO 分类的 A 和 B 型），采用髓内钉动力固定是安全的。对于这些骨折类型，应鼓励采用动力固定模式。
