Intramedullary fibular allograft and nail for treatment of femoral shaft nonunion.

We present a difficult case of hypertrophic nonunion associated with a large cavity in the lower third of the femur. The cavity had been created by a windshield-wiper effect after failure of fixation with a Schneider intramedullary rod in a patient weighing 450 pounds. Treatment consisted of exchanging the Schneider nail with a larger-diame-ter interlocking nail and using the intramedullary fibular allograft to fill the cavity. The fracture healed 4 months after the procedure. At 5-year follow-up, the patient had no complaint, and plain radiographs showed obliteration of the large cavity in the distal femur. Intramedullary fibular graft technique can be used as an adjunct to use of an intramedullary nail when the distal femur contains a large cavity or when the intramedullary rod does not provide adequate fixation stability.