Surgical Management of aseptic Femoral Shaft Non-union after Intramedullary Fixation

Abstract

Background : Several treatment modalities are available for handling of femoral nonunion after intramedullary nailing. These alternatives include nail dynamisation, external fixation, exchange nailing and Plate osteosynthesis. This treatment can be used as augmentation technique over a previous used intramedullary nail, with or without bone grafting Objective : To evaluate the outcome of femoral nonunion after intramedullary fixation by locked nail and management of 30 cases of aseptic femoral nonunion with nail exchange or augmentation with plate Patients and Methods : We reviewed 30 patients with femoral fracture nonunion after interlocking intramedullary nailing treated either with exchange nailing with or without bone graft or plate augmentation and bone grafting with the nail in situ. The mean time from primary nailing to exchange nailing or plate augmentation and bone grafting was 9.80 +/- 5.45 months for achieving stability of the fracture. We did exchange nailing with larger diameter nail or applying DCP plate on the lateral aspect of the femur Results : 27 patients achieved solid union in time ranged from 6-12 months with mean of 7.54 +/- 2.18 Conclusion : Exchange reamed intramedullary nailing has low morbidity, may obviate the need for additional bone grafting, and allows full weight-bearing and active rehabilitation provides extremely rigid fixation, and provides reason to allow patients to bear weight early in the postoperative period. Bone graft could be precisely placed in the fracture site if necessary.