ABSTRACT
The so-called "dynamization", i.e. the removal of defined bolts after the first signs of osseous consolidation detected by X-ray film 6 to 10 weeks after surgery employing the static locking nail technique, cannot be translated into reality. In a total of 121 patients in whom static locking nail technique had been employed, dynamization was effected in 23 cases only, i.e. 19%. Complications are likely to occur if the indication for dynamization was wrong or if dynamization is not performed although it was indicated. Dynamization must be prescribed individually on the basis of X-ray film controls and is actually indicated in rare cases only. We refuse to perform it as a routine step after static nail locking of the femur and tibia.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary/methods , Fractures, Open/surgery , Postoperative Complications/diagnostic imaging , Tibial Fractures/surgery , Wound Healing , Follow-Up Studies , Humans , RadiographyABSTRACT
The history of intramedullary nailing leads us to assume that septic complications arising from the treatment of open fractures through marrow nailing are largely due to reaming and need no longer to a full extent be put down to treatment by locking nailing. Locking nailing of an open fracture (all three degrees) of the femur can be recommended as long as the periosteum is not exposed over large segments, and coverage with soft tissue is possible. Locking nailing of the lower leg can only be recommended with open fractures of the first degree. With fractures of the second and third degrees the fixateur externe is the treatment of choice.
