A comparative study of the effect of early versus late dynamization of external fixator in the treatment of compound fracture of tibia: a non-randomized controlled trial

Background: Dynamization is commonly employed to enhance fracture healing following stabilization with external fixators or intramedullary nails. However, the optimal timing of dynamization remains controversial, with limited consensus in clinical practice. The aim was to compare the radiological and functional outcomes of early versus late dynamization in patients with tibial fractures treated using external fixation and to determine the optimal timing for dynamization. Methods: This prospective comparative study included 36 patients with open tibial fractures managed with external fixation. Patients were equally divided into two groups: group I (early dynamization, initiated at 2-4 weeks postoperatively) and group II (late dynamization, initiated at or after 4 weeks). Patients were followed up for fracture union, time to union, complications, pain, range of motion, need for secondary procedures, and functional outcome using the Baird and Jackson scoring system. Statistical analysis was performed to compare outcomes between the two groups. Results: Fracture union was achieved in 94.4% of patients in the early dynamization group compared to 72.2% in the late dynamization group. The mean time to union was significantly shorter in group I (12.65±5.49 weeks) than in group II (18.46±4.61 weeks; p=0.005). Complication rates, including pin tract infection and limb shortening, were lower in the early dynamization group. Functional outcomes were favorable in both groups; however, excellent Baird and Jackson scores were more frequent in the early dynamization group. Pain relief and restoration of joint range of motion were achieved earlier in patients undergoing early dynamization. Conclusions: Early dynamization within four weeks of surgery results in faster fracture union and better functional outcomes compared to late dynamization. Early dynamization should be considered the preferred strategy in the management of tibial fractures treated with external fixation.