The Effect of Dynamization Versus Non-dynamization in the Union of Tibia Shaft Fracture-A Case-control Study

Background: Tibial shaft fractures are common long bone injuries, especially in children and adolescents, with an incidence of 15.7 to 16.9 per 100,000 individuals annually. High-energy tibial fractures are more prevalent in males. Closed fractures occur without skin disruption, while open fractures expose the bone, making them prone to complications like infection. Treatment typically involves intramedullary nailing (IMN), achieving 90-100% union rates. Complications such as delayed union can arise with treatments like dynamization or nailing exchange. The effectiveness of dynamization varies, with success rates influenced by factors like fracture type and healing conditions. Aim of the study: The study aims to evaluate and compare the impact of dynamization versus non-dynamization on the union of tibia shaft fractures in patients undergoing treatment, as determined through clinical outcomes and fracture healing rates. Methods: This retrospective case-control study was conducted at Department of Orthopedics Surgery, Bangabandhu Sheikh Mujib Medical University in Bangladesh, included 100 patients with closed and open grade 1 tibia shaft fractures treated with tibia intramedullary interlocking nailing. The patients were divided into two groups: 50 underwent dynamization at surgery onset (case group), and 50 did not (control group). Inclusion criteria focused on patients over 18 years with tibial diaphyseal fractures, while exclusion criteria eliminated cases with associated intra-articular or severe open fractures. Fracture healing was evaluated over 24 weeks, with statistical analysis performed using SPSS version 26.0, considering a p-value <0.05 as significant. Results: In this compared study, the highest age group in both groups was 30-39 years (case: 40%, control: 50%). Males dominated both groups (case: 70%, control: 72%). Road traffic accidents were the primary cause of injury (case: 66%, control: 60%). Closed fractures were predominant (case: 88%, control: 98%). Clinical outcomes were similar between the groups, with fair outcomes being the most common (case: 46%, control: 44%). There was no significant difference in outcomes, suggesting comparable treatment approaches. Conclusion: Dynamization showed a trend towards better clinical outcomes in tibia shaft fracture treatment, though not statistically significant. Radiographical follow-ups indicated improvement. Future research with larger samples is needed to clarify its role. Clinicians should tailor the use of dynamization based on individual patient characteristics and fracture specifics.