Combination of exchange nailing augmented with plate and allograft in treating femoral shaft nonunion after intramedullary nailing – Our experience

Abstract

Risk factors for femoral nonunion after intramedullary nailing are open fracture, delay in weight bearing, and tobacco use. The treatment of nonunion with a statically locked intramedullary nail in place is either bone grafting in situ, dynamization of the nail by locking screw removal, or exchange nailing. We combined exchange nailing augmented with plate and bone grafting to study its usefulness in treating femur shaft nonunions after nailing.We did a retrospective study. Cases were collected between Aug 2020-June 2022. 15 patients were collected. They had underwent intramedullary nailing for femur fracture. Infection was ruled out. Mean period for presentation of nonunion - 20 months after primary surgery. Initially old nail was removed. Then we freshened the ends of the nonunion till the ends bleed. Then we passed a nail, did distal interlocking and then added a plate. We used a muller device to compress the nonunion, added a bone graft & then finally locked proximally. All 15 of the patients achieved postoperative bony union uneventfully at a mean time of 22.1 weeks (range, 12–40 weeks). The mean operative time was 105 minutes (range, 60–150 minutes), and the mean blood loss was 340 ml (range, 150–700 ml). All of the patients could walk bearing full weight without pain within 3 months. There were no significant complications such as broken hardware, implant back-out, axial or rotational malalignment, or deep infections. Exchange nailing with plate and graft augmentation is a good option in treating femur shaft nonunions after open reduction and internal fixation with intramedullary nailing. We used exchange nailing augmented with plate and bone graft and found it to lead to union in 100% cases.