Effects of different dynamic methods in the treatment of poor healing after tibial fracture fixed by intramedullary nailing
Objective To analyze the impact of different dynamic treatments on tibial shaft fracture following intramedullary nail fixation and provide clinical treatment references.Methods This retrospective analysis was conducted at the Department of Orthopedics,Jiangjin Hospital Affiliated to Chongqing University,from August 2003 to August 2023.Clinical data of 30 patients with poor healing of tibial shaft fractures after interlocking intramedullary nail fixation were included.The patients were divided into two groups based on the method of dynamization:distal dynamization group(n=22)included 8 males and 14 females with an average age of 43.86 years;proximal dynamic group(n=8)included 6 males and 2 females with an average age of 45 years.Parameters such as dynamic operation time,blood loss,final fracture healing status,limb shortening after fracture healing,operation time for internal fixation removal,intraoperative blood loss,and hospitalization cost for internal fixation removal were collected in both groups.Statistical analysis using SPSS was performed to evaluate whether there were statistically significant differences between the two groups.Results There was no significant difference between the two groups in terms of dynamic operation duration,blood loss volume,and rate of shortening in the affected limb.However,the proximal group had a relatively lower frequency of fluoroscopy during dynamic surgery[(1.13±0.35)vs.(1.50±0.51)]and showed a better rate of fracture healing in the later stage compared to the distal dynamic group(87.50%vs.54.55%)with statistical significance(P<0.05).Among patients with fracture healing,the distal dynamic group had shorter operative time for internal fixation extraction[(59.75±18.03)min vs.(93.43±25.16)min],less intraoperative blood loss[(15.31±11.03)ml vs.(60.00±23.09)ml],lower intraoperative fluoroscopy frequency[(1.44±0.63)vs.(3.14±0.90)],and lower hospitalization costs[(7077.31±613.37)vs.(7999.29±547.18)]compared to the proximal dynamic group;these differences were statistically significant(P<0·05).However,there was no significant difference between the two groups in terms of length of stay and postoperative pain score.Conclusions Both distal and proximal dynamic treatments are effective for poor healing after tibial fractures.The success rate is relatively higher with proximal dynamic treatment;however,fixed extraction is more challenging in later stages.
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