Plate augmentation for femoral nonunion: more than just a salvage tool?
Orthopaedic Surgery
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Abstract
Objective
The aim of the current study was to determine whether plate augmentation was a successful treatment algorithm for selected femoral nonunions initially managed with intramedullary nailing.
Materials and methods
A total of 30 femoral nonunion cases were managed using the plate augmentation strategy with 13 primary cases and 17 multi-operated femurs (avg 2.8 ineffective procedures). Adjunctive strategies included autologous bone grafting and/or BMP for atrophic/oligotrophic and bone defect cases. Deformity correction was performed when required.
Results
Osseous union occurred in 29 of 30 cases. One multi-operated case with bone defect and prior infection required repeat autologous grafting prior to union.
Conclusion
Plate augmentation should be added to the armamentarium for management of selected femoral nonunion that have failed initial intramedullary nailing.
Keywords
Femur nonunion Plate augmentation Intramedullary nail Bone graft Exchange nailReferences
- 1.Winquist RA, Hansen ST, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66:529–539PubMedGoogle Scholar
- 2.Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE (2009) Risk factors for femoral nonunion after femoral shaft fracture. J Trauma 67(6):1389–1392CrossRefPubMedGoogle Scholar
- 3.Canadian Orthopaedic Trauma Society (2003) Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am 85(11):2093–2096Google Scholar
- 4.Tay WH, de Steiger R, Richardson M, Gruen R, Balogh ZJ (2014) Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures. Injury 45(10):1653–1658. doi: 10.1016/j.injury.2014.06.025 CrossRefPubMedGoogle Scholar
- 5.Pihlajamaki HK, Salminen ST, Bostman OM et al (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. JOT 16:394–402Google Scholar
- 6.Wu CC, Chen WJ (1993) Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg 36:302–306PubMedGoogle Scholar
- 7.Papakostidis C, Psyllakis I, Vardakas D, Grestas A, Giannoudis PV (2011) Femoral-shaft fractures and nonunions treated with intramedullary nails: the role of dynamisation. Injury 42(11):1353–1361CrossRefPubMedGoogle Scholar
- 8.Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA (2009) The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma 23(9):653–657CrossRefPubMedGoogle Scholar
- 9.Hierholzer C, Glowalla C, Herrler M, von Rüden C, Hungerer S, Bühren V et al (2014) Reamed intramedullary exchange nailing: treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res 9(1):88PubMedCentralCrossRefPubMedGoogle Scholar
- 10.Swanson EA, Garrard EC, Bernstein DT, O’Connor DP, Brinker MR (2015) Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma 29(1):21–27CrossRefPubMedGoogle Scholar
- 11.Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89(1):177–188CrossRefPubMedGoogle Scholar
- 12.Hak DJ, Lee SS, Goulet JA (2000) Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma 14(3):178–182CrossRefPubMedGoogle Scholar
- 13.Webb LX, Winquist RA, Hansen ST (1986) Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. Clin Orthop 212:133–141PubMedGoogle Scholar
- 14.Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ (2000) Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma 14(5):335–338CrossRefPubMedGoogle Scholar
- 15.Ueng SW, Chao EK, Lee SS, Shih CH (1997) Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 43(4):640–644CrossRefPubMedGoogle Scholar
- 16.Choi YS, Kim KS (2005) Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop 29(5):287–290PubMedCentralCrossRefPubMedGoogle Scholar
- 17.Nadkarni B, Srivastav S, Mittal V, Agarwal S (2008) Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486CrossRefPubMedGoogle Scholar
- 18.Gao KD, Huang JH, Tao J, Li F, Gao W, Li HQ et al (2011) Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft. Orthop Surg 3(2):83–87CrossRefPubMedGoogle Scholar
- 19.Ye J, Zheng Q (2012) Augmentative locking compression plate fixation for the management of long bone nonunion after intramedullary nailing. Arch Orthop Trauma Surg 132(7):937–940CrossRefPubMedGoogle Scholar
- 20.Hakeos WM, Richards JE, Obremskey WT (2011) Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting. J Orthop Trauma 25(2):84–89CrossRefPubMedGoogle Scholar
- 21.Lin CJ, Chiang CC, Wu PK, Chen CF, Huang CK, Su AW et al (2012) Effectiveness of plate augmentation for femoral shaft nonunion after nailing. J Chin Med Assoc 75(8):396–401CrossRefPubMedGoogle Scholar
- 22.Wang Z, Liu C, Liu C, Zhou Q, Liu J (2014) Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing. Int Orthop 38(11):2343–2347CrossRefPubMedGoogle Scholar
- 23.Park K, Kim K, Choi YS (2011) Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop 35(4):581–585PubMedCentralCrossRefPubMedGoogle Scholar
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