Plate augmentation and bone grafting in treatment of femoral shaft nonunion initially fixed by intramedullary nail

Abstract

Introduction: This study aims to evaluate the results of plate augmentation and bone grafting without removing the nail in the treatment of nonunited, nailed femoral shaft fractures.

Methods: Twenty patients with atrophic nonunion femoral shaft fractures initially fixed by intramedullary nail were treated by augmentation plating and iliac bone graft with retention of the nail. Patients were evaluated at regular intervals using an X-ray and Wu scoring system, which assesses clinical and radiological signs of healing.

Results: All 20 patients achieved bony union at a mean time of 4.9 months (3-8 months). According to Wu's score, 12 cases showed excellent results, and 8 cases obtained good results with no complications recorded.

Conclusion: augmentation plating and iliac bone graft provide a good and safe method of treatment of previously nailed and non-united femoral shaft fractures.

Level of evidence: Level 4; Case Series.

Keywords: Bone graft; Femoral shaft; Intramedullary nail; Nonunion; Plate augmentation.

Figure 1

Twenty-three year-old lady with atrophic nonunion fracture shaft Rt femur fixed by intramedullary interlocking nail. A. Preoperative X-ray, 9 months after nail fixation, showing; atrophic nonunion at the fracture site. B. Immediate postoperative X-ray after plate and graft augmentation. The fracture was fixed by broad DCP and 8 bicortical screws. The graft can be seen filling the nonunion site. C. 3 months postoperative X-ray showing; complete bone union with good consolidation at fracture site.