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. 2019 Mar 25;20(1):127.
doi: 10.1186/s12891-019-2514-3.

Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study

Po-Ju Lai  1 , Yung-Heng Hsu  1 , Ying-Chao Chou  1 , Wen-Ling Yeh  1 , Steve W N Ueng  2 , Yi-Hsun Yu  3
Affiliations

Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study

Po-Ju Lai et al. BMC Musculoskelet Disord. .

Abstract

Background: Atrophic nonunion of femoral shaft fracture after intramedullary (IM) nailing is uncommon. The treatment for femoral shaft aseptic atrophic non-union remained controversial. The aim of this study was to compare the surgical results between exchanging reamed nailing (ERN) and augmentative antirotational plating (AAP) for femoral shaft aseptic atrophic nonunion.

Methods: We retrospectively reviewed the patients with femoral shaft nonunion between the year of 2014 and 2015. The patients with nonunion after plate osteosynthesis, septic nonunion, hypertrophic nonunion, additional surgery during revision surgery were excluded. All the patients were followed up at least 12 months.

Results: Overall, the union rate after revision surgery was 70.8%. The union rate was significantly higher in the AAP group than in the ERN group. Operating time was also significantly shorter in the AAP group. Regarding the location of nonunion, the union rate was comparable between groups for isthmic nonunions. However, for non-isthmic nonunions, the union rate was significantly higher and operating time was significantly shorter in the AAP group.

Conclusion: AAP showed an overall higher union rate for management of femoral shaft aseptic atrophic nonunion compared with ERN. Especially for non-isthmic femoral shaft atrophic nonunions, AAP provided a significantly higher union rate and significantly shorter operating time.

Keywords: Augmentative plate; Exchanging reamed nail; Nonunion femoral shaft fracture.

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Conflict of interest statement

Ethics approval and consent to participate

  1. The study protocol was approved by the Institutional Review Board (No. 201600790B0) of Chang Gung Memorial Hospital.

  2. The consent obtained from study participants was written.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
A 48-year-old woman who had a motor vehicle accident. a Right femoral shaft fracture. b and c Twelve months after intramedullary (IM) nail fixation with nonunion. d Exchanging reamed nailing with a larger diameter IM nail. e and f Solid union at 8 months after surgery
Fig. 2
Fig. 2
A 38-year-old woman who had a motor vehicle accident. a Left femoral shaft fracture below the isthmus. b and c Twelve months after intramedullary nail fixation with atrophic nonunion. d Augmentative antirotational plating with a dynamic compression plate. e and f Solid union at 5 months after surgery
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