Retaining intramedullary nail with plate fixation outperforms nail removal and double-plate fixation in femoral shaft nonunion.

PURPOSE: This retrospective study aimed to compare the efficacy of augmented plate fixation with autogenous hybrid bone grafting (Group A) and vertical double-plate fixation with autogenous bone grafting through channels after removal of the original intramedullary nail (IMN) (Group B) for the treatment of atrophic nonunion of femoral shaft after IMN.

METHODS

In the retrospective study, 56 patients who were diagnosed atrophic femoral nonunion after IMN fixation were enrolled and evaluated from January 2019 to July 2024 in Xi'an Honghui Hospital. All cases were fixed with either group A (n = 29) or group B (n = 27). Operation time, total blood loss, visual analog scale (VAS) scores, time to union, union rate, and the surgical complications were compared between the two groups.

RESULTS

The results showed that Group A had a shorter operation time (96.2 ± 22.9 min vs. 122.4 ± 30.6 min; p < 0.001), less total blood loss (320.5 ± 98.7 m vs. 645.8 ± 142.3 mLL; p < 0.001), lower VAS scores at postoperative day 3 (5.0 ± 1.0 vs. 6.9 ± 1.1, p < 0.05), and significantly shorter radiographic union time (5.0 ± 1.4 vs.6.6 ± 1.6 months, p < 0.05). There was no significant difference in the surgical complications between the two groups.

CONCLUSION

The method of retaining the original intramedullary nail using hybrid bone grafting combined with local augmented plate fixation had a shorter operation time, less total blood loss, lower VAS scores, and shorter union time compared to the method of removing the original intramedullary nail, performing channel bone grafting, and using vertical double-plate fixation. In clinical practice, the treatment method of retaining the original intramedullary nail using hybrid bone grafting combined with local augmented plate fixation may be a more preferable treatment option for atrophic nonunion of femoral shaft after intramedullary nailing.