Nonunion after intramedullary nailing of femoral and tibial fractures, although infrequent, remains a challenge for orthopedic surgeons. Augmentation plate fixation can be a reasonable choice in this situation. From 2003 to 2005, 38 patients (25 femoral nonunions and 13 tibial nonunions) were treated after intramedullary nailing with augmentation plate fixation, leaving the nail in situ, with or without autogenous cancellous bone graft. Patients were followed for at least 1 year postoperatively. All 25 femoral nonunions healed with solid union (100% union rate), but 2 of 13 tibial nonunions remained symptomatic and did not achieve union (84.6% union rate) at a mean 4.78 months postoperatively (range, 1-6 months). No serious complications were encountered at 1-year follow-up. We suggest augmentation plate fixation for femoral and tibial nonunion after intramedullary nailing.

Osteoid osteoma is a benign tumor commonly found in young patients. The most interesting feature of the tumor is its peculiar obvious pain. The intensity of pain produced by osteoid osteoma is unproportionate to its nature and size. Much has been written about the mechanism of this symptom of the tumor and the specific characteristics of the pain that can be misleading when appearing as radicular pain especially when some subtle neurologic signs and symptoms accompany the pain. In this article, 12 patients who were referred to our clinic with radicular pain and neurological signs and symptoms months after initiation of symptoms between 2000 and 2008 are presented. Of these 12 patients, most were first thought to have root compression disease before being referred to our hospital. Precise history taking and special attention to physical examinations led to a suspicion of osteoid osteoma. Plain radiographs, computed tomography, and bone scans indicated osteoid osteoma, and excisional biopsy confirmed its diagnosis. Osteoid osteoma should always be considered in young patients with radicular pain, even with subtle neurological signs and symptoms.