Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing.

PURPOSE: We assessed indications and outcomes of exchange nailing and augmentation plating for femoral shaft nonunion following femoral nail failure.

METHODS

We retrospectively reviewed the records of 21 consecutive patients with femoral shaft nonunion treated with femoral nailing from August 2008 to June 2013. Nonunion cases with infection were excluded from this study. The study population consisted of nine men and 12 women, with an average age of 40 (range 21-61) years. All patients received internal fixation using exchange nailing and an augment plate coupled with decortication and bone graft.

RESULTS

All patients in our study obtained osseous union with a mean time of six (range four to12) months. Mean operation time was three hours (range two to five hours), and mean blood loss was 800 ml (range 500-950 ml). There were no postoperative complications. At the last follow-up, all patients could flex their knees > 110°.

CONCLUSIONS

Exchange nailing and augment plating coupled with decortication and bone graft is an effective treatment option for femoral shaft nonunion and has more indications and higher union rate than the popular exchange nailing treatment.