Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion

Abstract

BackgroundThe aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures.MethodsBetween 2003 and 2010, 72 consecutive patients with nonunion of the femoral shaft were operated using a standardized protocol in our trauma department and followed up for successful union and functional result.ResultsOsseous healing was observed in 71 patients (98%). Only one patient was lacking bone healing following a time period of 24 months after the first exchange nailing and 5 months after the second exchange nailing. In 59 patients (82%), uneventful and timely bone healing after exchange nailing was detected. In 18% of patients (n = 13), delayed bone healing was observed and required additional therapy. In the majority of patients (61%), bone healing occurred within the first 2 to 5 months, only 18% of patients’ duration of bone healing exceeded 8 months. In 62 patients (86%), no relevant or clinically apparent leg-length discrepancy prior to and after exchange nailing was detected as well as no significant axis deviation or malrotation. Functional studies including simple clinical gait and standing analysis, return to activities of daily life, return to sports activities, and return to work were all reached on a satisfying level.DiscussionReamed intramedullary exchange nailing as described in this study is the treatment of choice for aseptic femoral shaft nonunion with a high rate of bone healing and a low rate of complications including length discrepancy or malrotation and a good functional outcome.

Complication of a Femoral Fracture Treated by Intramedullary Nailing - Numerical Analysis of a Clinical Case

“…Jed ną z po wa żniej szych, mo żli wych kom pli ka cji jest brak, mi mo sta bi li za cji zła ma nia, zro stu kost ne go i w dal szej ko lej no ści po wsta nie sta wu rze ko me go [5][6][7]. Kon se kwen cje zła ma nia, jak i ro ko wa nie są za wsze po wa żne i szcze gól nie w star szym wie ku le cze nie, ze wzglę du na wy so kie ry zy ko kom pli ka cji, po win no być do kład nie pla no wa ne [8][9][10]. Te go ty pu uraz, ze wzglę -du na ból, mo żli we licz ne czyn ni ki nie po wo dze nia i kom pli ka cje oraz znacz ne ogra ni cze nie mo bil no ści pa cjen ta sta no wi rów nież po wa żny pro blem na tu ry społecz nej i eko no micz nej [11][12][13][14].…”

“…Do pod sta wo wych czyn ni ków wa run ku ją cych wła ści wy zrost kost ny na le żą od po wied nia re po zy cja odła mów oraz od two rze nie wa sku la ry za cji [10,19,20].…”

“…One of the most important possible complications is bone non-union despite previous fracture stabilisation, followed by the development of a pseudarthrosis [5][6][7]. The prognosis and consequences of fractures are always serious and especially at older age treatment should be planned carefully due to a high risk of complications [8][9][10]. Because of the pain and the presence of many possible failure factors and complications as well as significant limitation of patient mobility, this type of injury also represents a serious social and economic problem [11][12][13][14].…”

“…The basic determinants of appropriate bone adhesion comprise appropriate repositioning of fragments and restitution of vascular supply [10,19,20].…”

A Biomechanical Comparison of a Novel Expandable Photodynamic Intramedullary System to a Metal Plate and Screw System in Humerus and Femur Osteotomy Models

“…1,2 Internal fixation needs to provide enough rigidity, compression, and have adequate durability (fatigue life) to promote bone healing. 2,3 Intramedullary rods are implanted along the axis of the center of mass and provide better durability than plates, but are not as rigid. 4 Implanted metal plates are fixed to cortical bone with screws, and can provide compression and better rigidity under conditions of good bone contact.…”