Radiological union analysis of femoral shaft aseptic nonunion after failed plate and screw convert to reaming intramedullary solid locking nail

Abstract

Background: Non-united fracture shaft of the femur after plate fixation is a common problem. Management of this problem is still controversial. There are many methods for treating femoral shaft aseptic nonunions with a broken implant which conversion to reaming solid intramedullary nail is one of the procedures. However, the reported success rate varies. This study aimed to evaluate bone healing, especially callus formation, radiologically after nonunion reconstruction using intramedullary nailing reaming. Method: This study is a cross-sectional retrospective case analysis presenting 22 patients with the patient’s age was 15 to 50 years old who underwent operation procedures managed by removing the hardware and converting to reaming solid intramedullary locking nail with or without autogenous iliac bone graft for at least six months. The bone healing process was assessed by serial plain radiography every six weeks using the Callus Index method. Results: Conversion to reaming solid intramedullary nailing after nonunion with broken implant gives union rate 95%. Among 22 patients, one patient persisted in nonunion, and two patients experience delayed union. The Callus index of Fracture location (P=0,043) significantly affected index callus formation (P<0.05); The fracture location, whereas fracture classification (P=0,365), nonunion type (P=0,398), and bone graft (P=0,510) did not significantly affect index callus formation (P>0.05). There was no significant difference in time to the solid union between patients with or without iliac autogenous bone graft. Proximal third nonunion affects the time to solid union. No significant complications were noted. Conclusion: Nonunion reconstruction using solid reaming nail at both types nonunion gives a solid union. Solid union achieves with or without bone graft.