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Archives of Orthopaedic and Trauma Surgery

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01-02-2016 | Orthopaedic Surgery

Plate augmentation for femoral nonunion: more than just a salvage tool?

Authors: J. C. Chiang, J. E. Johnson, I. S. Tarkin, P. A. Siska, D. J. Farrell, M. A. Mormino

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2016

Abstract

Objective

The aim of the current study was to determine whether plate augmentation was a successful treatment algorithm for selected femoral nonunions initially managed with intramedullary nailing.

Materials and methods

A total of 30 femoral nonunion cases were managed using the plate augmentation strategy with 13 primary cases and 17 multi-operated femurs (avg 2.8 ineffective procedures). Adjunctive strategies included autologous bone grafting and/or BMP for atrophic/oligotrophic and bone defect cases. Deformity correction was performed when required.

Results

Osseous union occurred in 29 of 30 cases. One multi-operated case with bone defect and prior infection required repeat autologous grafting prior to union.

Conclusion

Plate augmentation should be added to the armamentarium for management of selected femoral nonunion that have failed initial intramedullary nailing.

Winquist RA, Hansen ST, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66:529–539PubMed

Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE (2009) Risk factors for femoral nonunion after femoral shaft fracture. J Trauma 67(6):1389–1392CrossRefPubMed

Canadian Orthopaedic Trauma Society (2003) Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am 85(11):2093–2096

Tay WH, de Steiger R, Richardson M, Gruen R, Balogh ZJ (2014) Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures. Injury 45(10):1653–1658. doi:10.1016/j.injury.2014.06.025 CrossRefPubMed

Pihlajamaki HK, Salminen ST, Bostman OM et al (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. JOT 16:394–402

Wu CC, Chen WJ (1993) Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg 36:302–306PubMed

Papakostidis C, Psyllakis I, Vardakas D, Grestas A, Giannoudis PV (2011) Femoral-shaft fractures and nonunions treated with intramedullary nails: the role of dynamisation. Injury 42(11):1353–1361CrossRefPubMed

Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA (2009) The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma 23(9):653–657CrossRefPubMed

Hierholzer C, Glowalla C, Herrler M, von Rüden C, Hungerer S, Bühren V et al (2014) Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res 9(1):88PubMedCentralCrossRefPubMed

10.

Swanson EA, Garrard EC, Bernstein DT, O’Connor DP, Brinker MR (2015) Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma 29(1):21–27CrossRefPubMed

11.

Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89(1):177–188CrossRefPubMed

12.

Hak DJ, Lee SS, Goulet JA (2000) Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma 14(3):178–182CrossRefPubMed

13.

Webb LX, Winquist RA, Hansen ST (1986) Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. Clin Orthop 212:133–141PubMed

14.

Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ (2000) Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma 14(5):335–338CrossRefPubMed

15.

Ueng SW, Chao EK, Lee SS, Shih CH (1997) Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 43(4):640–644CrossRefPubMed

16.

Choi YS, Kim KS (2005) Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop 29(5):287–290PubMedCentralCrossRefPubMed

17.

Nadkarni B, Srivastav S, Mittal V, Agarwal S (2008) Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486CrossRefPubMed

18.

Gao KD, Huang JH, Tao J, Li F, Gao W, Li HQ et al (2011) Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft. Orthop Surg 3(2):83–87CrossRefPubMed

19.

Ye J, Zheng Q (2012) Augmentative locking compression plate fixation for the management of long bone nonunion after intramedullary nailing. Arch Orthop Trauma Surg 132(7):937–940CrossRefPubMed

20.

Hakeos WM, Richards JE, Obremskey WT (2011) Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting. J Orthop Trauma 25(2):84–89CrossRefPubMed

21.

Lin CJ, Chiang CC, Wu PK, Chen CF, Huang CK, Su AW et al (2012) Effectiveness of plate augmentation for femoral shaft nonunion after nailing. J Chin Med Assoc 75(8):396–401CrossRefPubMed

22.

Wang Z, Liu C, Liu C, Zhou Q, Liu J (2014) Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing. Int Orthop 38(11):2343–2347CrossRefPubMed

23.

Park K, Kim K, Choi YS (2011) Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop 35(4):581–585PubMedCentralCrossRefPubMed

Title: Plate augmentation for femoral nonunion: more than just a salvage tool?
Authors: J. C. Chiang
J. E. Johnson
I. S. Tarkin
P. A. Siska
D. J. Farrell
M. A. Mormino
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 2/2016
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-015-2365-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Plate augmentation for femoral nonunion: more than just a salvage tool?

Abstract

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusion

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