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Published in: European Journal of Trauma and Emergency Surgery 3/2016

01-06-2016 | Original Article

Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

Authors: H. R. Jhunjhunwala, A. A. Dhawale

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2016

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Abstract

Purpose

There are few reports of non-union femur shaft fractures treated with plate fixation with the nail in situ. This study reports our results in 40 cases.

Methods

Retrospective series of non-union and delayed union of femoral shaft after intramedullary nailing treated with plate fixation. Patients were serially followed-up till 12 months. Fracture union, time to union, knee range of motion, deformity, shortening and complications were recorded. Descriptive statistics were performed as applicable.

Results

There were 40 patients with mean age of 35 years (18–65). There were 14 cases of hypertrophic non-union, 24 cases of atrophic non-union and 2 cases of delayed union. The average time of surgery was 1 ½ h and average blood loss was 300 ml. Exchange nailing was done in 9 cases. Union was achieved in 39 patients. The mean time to fracture union was 4 months. Post-operative knee range of motion was >120° in 35 patients. One patient developed deep infection which was treated with removal of implants and exchange nailing with a vancomycin coated nail and union was achieved.

Conclusion

Plating is an effective treatment for non-union of diaphyseal femur fractures after intramedullary fixation with the nail in situ.
Literature
1.
go back to reference Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 cases. Clin Orth Relat Res. 1986;212:133–41. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 cases. Clin Orth Relat Res. 1986;212:133–41.
2.
go back to reference Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: fracture-healing with static interlocking fixation. J Bone Joint Surg Am. 1988;70(10):1453–62.PubMed Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: fracture-healing with static interlocking fixation. J Bone Joint Surg Am. 1988;70(10):1453–62.PubMed
3.
go back to reference Gelalis ID, Politis AN, Arnaotoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karaqeorqos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury. 2012;43(7):980–8.CrossRefPubMed Gelalis ID, Politis AN, Arnaotoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karaqeorqos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury. 2012;43(7):980–8.CrossRefPubMed
4.
go back to reference Ueng SWN, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1995;43:640–4.CrossRef Ueng SWN, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1995;43:640–4.CrossRef
5.
go back to reference Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for nonunion of femoral shaft fractures. Int Orthopaedics. 2005;29(5):287–90.CrossRef Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for nonunion of femoral shaft fractures. Int Orthopaedics. 2005;29(5):287–90.CrossRef
6.
go back to reference Said GZ, Said HG, El-Sharkawi MM. Failed intramedullary nailing of the femur: open reduction and plate augmentation with the nail in situ. Int Orthopaedics. 2011;35(7):1089–92.CrossRef Said GZ, Said HG, El-Sharkawi MM. Failed intramedullary nailing of the femur: open reduction and plate augmentation with the nail in situ. Int Orthopaedics. 2011;35(7):1089–92.CrossRef
7.
go back to reference Winquist RA, Hansen SJ. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am. 1980;11(3):633–48.PubMed Winquist RA, Hansen SJ. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am. 1980;11(3):633–48.PubMed
8.
go back to reference Heppenstall RB. Fracture treatment and healing. Eastbourne: Saunders; 1980. ISBN 978-0721646381. Heppenstall RB. Fracture treatment and healing. Eastbourne: Saunders; 1980. ISBN 978-0721646381.
9.
go back to reference Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orth Rel Res. 1986;212:18–25. Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orth Rel Res. 1986;212:18–25.
10.
go back to reference Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000;14(5):335–8.CrossRefPubMed Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000;14(5):335–8.CrossRefPubMed
11.
go back to reference Park K, Kim K, Choi YS. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop. 2011;35(4):581–5.CrossRefPubMedPubMedCentral Park K, Kim K, Choi YS. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop. 2011;35(4):581–5.CrossRefPubMedPubMedCentral
Metadata
Title
Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?
Authors
H. R. Jhunjhunwala
A. A. Dhawale
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 3/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0534-8

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