Is Nail Dynamization Useful In Delayed Union of Tibial Shaft Fractures? A Systematic Review and Meta-Analysis

Background: Nail dynamization is a controversial strategy used to treat delayed union in tibial shaft fractures. Reported union rates of nail dynamization varies within a wide range that goes from 19% to 100%. The purpose of this study was to perform a systematic review and a metaanalysis of the literature to explore post-dynamization union rates in cases of delayed union of tibial fractures following locked intramedullary nailing. Methods and Findings: This systematic review was conducted following the PRISMA (Preferred Reported Items for Systematic Reviews and Meta-Analyses) guidelines. We searched the Cochrane Database, PubMed, and the first 100 references of Google Scholar to June 2020. Inclusion criteria were as follows: English-language original research articles that included patients over 14 years of age with tibial shaft fractures treated with locked intramedullary nailing and posterior dynamization of static screws. Methodology quality was assessed using a modified version of Coleman’s score. We identified 14 studies that included 1198 fractures for full analysis. The mean age was 35.8 (range; 14-82 years) and the average follow-up period was 27 months (range; 3-100). Statically locked intramedullary nails were found in 922 (76.9%) fractures. Dynamization was reported