Plate augmentation and bone grafting in treatment of femoral shaft nonunion initially fixed by intramedullary nail

Abstract

Introduction: This study aims to evaluate the results of plate augmentation and bone grafting without removing the nail in the treatment of nonunited, nailed femoral shaft fractures. Methods: Twenty patients with atrophic nonunion femoral shaft fractures initially fixed by intramedullary nail were treated by augmentation plating and iliac bone graft with retention of the nail. Patients were evaluated at regular intervals using an X-ray and Wu scoring system, which assesses clinical and radiological signs of healing. Results: All 20 patients achieved bony union at a mean time of 4.9 months (3–8 months). According to Wu’s score, 12 cases showed excellent results, and 8 cases obtained good results with no complications recorded. Conclusion: augmentation plating and iliac bone graft provide a good and safe method of treatment of previously nailed and non-united femoral shaft fractures. Level of evidence: Level 4; Case Series.

Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review

“…The remaining 158 studies were analyzed in detail. Finally, 24 studies fit our inclusion criteria and were included in the study [ 2 , 8 , 11 , 12 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ] ( Figure 1 ).…”

“…Out of 24 selected studies, 21 were retrospective [ 2 , 8 , 11 , 12 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 36 , 37 ] and 3 prospective [ 33 , 34 , 35 ] ( Table 1 ).…”

“…In 12 studies [ 12 , 17 , 18 , 20 , 21 , 24 , 26 , 27 , 28 , 31 , 34 , 37 ], the NU localization was reported. For a total of 314 patients, 53.5% of NUs (168 cases) were in the middle third of the diaphysis, 31.5% (99 cases) in the distal third, and 15.0% (47 cases) in the proximal third.…”

“…For a total of 314 patients, 53.5% of NUs (168 cases) were in the middle third of the diaphysis, 31.5% (99 cases) in the distal third, and 15.0% (47 cases) in the proximal third. The type of NU was specified in 13 articles [ 2 , 8 , 12 , 17 , 18 , 20 , 24 , 25 , 26 , 28 , 30 , 31 , 37 ], with a total of 323 patients. The cases were atrophic NUs in 200 cases (61.9%) and hypertrophic NUs in 123 cases (38.1%).…”

“…In 18 studies, a bone union of 100% [ 2 , 11 , 20 , 21 , 22 , 23 , 24 , 24 , 25 , 27 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 37 ] was reported; in 4 studies, bone union was reported between 95% and 100% [ 17 , 18 , 28 , 36 ]; and in 2 studies, bone union was between 85% and 90% [ 8 , 12 ].…”