Treatment of aseptic nonunion after intramedullary nailing fixation with locking plate

Abstract

Objective: To evaluate the safety and efficacy of locking plate combined with bone grafting in the treatment of aseptic nonunion following intramedullary nailing fixation of fractures of the long bones.

Methods: Thirty-eight consecutive patients treated in our hospital between January 2004 and December 2006 were included in this retrospective study. The nonunions included 20 femurs, 15 tibias, and 3 humeri. The duration of non-union ranged from 6 to 84 months and 21 (55.3%) of them were located around the metaphysis of the affected long bones. There were 12 women and 26 men with a mean age of 39.2 years (range, 9-70 years). Locking plate combined with bone grafting was the procedure chosen to treat every case of nonunion in this series. The clinical outcomes were evaluated.

Results: All patients were followed up for 6-20 months (average 11.6 months). After locking plate fixation combined with bone grafting, union was achieved in all cases, the average healing time being 5.3 months (range, 4-8 months). Infection of the superficial incision occurred in three cases (7.9%) and delayed healing of the incision in one case, all of which healed with no further complications. The function of the adjacent joints was excellent to good in 30 patients (78.9%), fair in 7 (18.4%) and poor in 1 (2.6%) after follow-up.

Conclusion: Locking plate fixation combined with bone grafting is a highly effective treatment for aseptic nonunions of the long bones after intramedullary nailing fixation, especially in the case of metaphyseal nonunion.

Figure 1

A 55‐year‐old man with left tibial and fibular fractures. (A) Preoperative radiograph showing that the intramedullary nail is loose, nonunion was diagnosed 12 months after the fractures; (B) Postoperative radiograph showing fixation with LCP combined with bone grafting; (C) Radiograph at 6 months post surgery showing that the nonunion has healed. Function was excellent by 12 months post surgery.

Figure 2

A 34‐year‐old woman with fractures of the right distal humeral and olecranon fixed with an intramedullary nail. Nonunion was diagnosed after 15 months. (A) Preoperative radiograph showing the two distal locking screw nails are loose; (B) Postoperative radiograph showing fixation with LCP combined with bone grafting in the humerus and fixed with a hollow screw in the olecranon; (C) Radiograph 12 months post surgery showing the nonunion has healed, function is good.