The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series

Babak  Siavashi; Mohammad Soleimani; Mohammadreza Golbakhsh; Mohammad Rastegar; Seyyed Hossein Shafiei

doi:10.18502/jost.v8i2.9312

Babak Siavashi Associate Professor, Orthopedic Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Soleimani Orthopedic Assistant, Orthopedic Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Golbakhsh Associate Professor, Orthopedic Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Mohammad Rastegar Orthopedic Assistant, Orthopedic Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Seyyed Hossein Shafiei Assistant Professor, Orthopedic Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v8i2.9312

Keywords: Femoral Fractures; Bone; Bone Fractures; Bone Transplantation; Fracture Malunion

Abstract

Background: Several treatment approaches are now considered to manage femoral nonunion following intramedullary (IM) nailing. Augmentation plating over a maintained IM nail was a successful treatment for femur fracture nonunion in recent years. We aimed to describe our experiences in evaluating the union of bone for these patients after plate augmentation with serial examinations and radiologic studies.

Methods: This was a case study on 21 patients who had a nonunion or delayed union of the femoral shaft fracture (FSF) after IM nailing. After initial intervention, they were monitored for 20.4 months (range: 12-72 months).

Results: A closed IM nail was used in 18 patients, while the other three patients were shown as non-IM nail cases with a dynamic hip screw (DHS) in one patient, an external fixator in one other patient, and plate fixation in another one that was planned for augmentation plating. After plating, appropriate union appeared in all patients. Fracture union took an average of 7 months ranging from 3 to 12 months.

Conclusion: Augmentation plating for treating FSF nonunion with leaving the nail in place results in excellent and favorable clinical outcomes with the radiographic recovery of the nonunion site in all of the cases with no complication.