Osteoperiosteal Decortication And Bone Grafting Combined With Wave Plating For Treating Femoral Shaft Aseptic Atrophic Nonunion After Intramedullary Nailing

Abstract

Introduction: Nonunion of the femoral shaft after intramedullary nailing fixation remains a challenge for orthopedic surgeons. This study aimed to evaluate osteoperiosteal decortication and iliac bone graft combined with wave plating for treating femoral shaft aseptic atrophic nonunion after intramedullary nailing.Methods: This retrospective study included 22 patients (2 women, 20 men with a mean age of 40.8 years [range, 19–61 years]) with femoral shaft aseptic atrophic nonunion that were treated with osteoperiosteal decortication and iliac bone graft combined with wave plating between January 2016 and January 2020. Cases of infected nonunion, hypertrophic nonunion, and nonunion after plate osteosynthesis were excluded. The clinical outcomes were assessed by the Samantha radiographic grading scale and the Paley scale.Results: The mean follow-up period was 18.8 months (range, 12–35 months). Bone union was achieved in 22 patients. Union was achieved eventually in two cases. The average clinical healing time for nonunion was 5.7 months (range, 3–14 months). The mean Samantha X-ray score was 5.7 ± 0.45. All patients showed excellent and good clinical results (Paley). One patient developed a superficial infection that was cured after a dressing change. Conclusions: Osteoperiosteal decortication and bone graft combined with wave plating is an excellent method for treating femoral shaft aseptic atrophic nonunion after intramedullary nailing.