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Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript



There are few reports of non-union femur shaft fractures treated with plate fixation with the nail in situ. This study reports our results in 40 cases.


Retrospective series of non-union and delayed union of femoral shaft after intramedullary nailing treated with plate fixation. Patients were serially followed-up till 12 months. Fracture union, time to union, knee range of motion, deformity, shortening and complications were recorded. Descriptive statistics were performed as applicable.


There were 40 patients with mean age of 35 years (18–65). There were 14 cases of hypertrophic non-union, 24 cases of atrophic non-union and 2 cases of delayed union. The average time of surgery was 1 ½ h and average blood loss was 300 ml. Exchange nailing was done in 9 cases. Union was achieved in 39 patients. The mean time to fracture union was 4 months. Post-operative knee range of motion was >120° in 35 patients. One patient developed deep infection which was treated with removal of implants and exchange nailing with a vancomycin coated nail and union was achieved.


Plating is an effective treatment for non-union of diaphyseal femur fractures after intramedullary fixation with the nail in situ.

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  1. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 cases. Clin Orth Relat Res. 1986;212:133–41.

    Google Scholar 

  2. Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: fracture-healing with static interlocking fixation. J Bone Joint Surg Am. 1988;70(10):1453–62.

    CAS  PubMed  Google Scholar 

  3. Gelalis ID, Politis AN, Arnaotoglou CM, Korompilias AV, Pakos EE, Vekris MD, Karaqeorqos A, Xenakis TA. Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. Injury. 2012;43(7):980–8.

    Article  PubMed  Google Scholar 

  4. Ueng SWN, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1995;43:640–4.

    Article  Google Scholar 

  5. Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for nonunion of femoral shaft fractures. Int Orthopaedics. 2005;29(5):287–90.

    Article  CAS  Google Scholar 

  6. Said GZ, Said HG, El-Sharkawi MM. Failed intramedullary nailing of the femur: open reduction and plate augmentation with the nail in situ. Int Orthopaedics. 2011;35(7):1089–92.

    Article  Google Scholar 

  7. Winquist RA, Hansen SJ. Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am. 1980;11(3):633–48.

    CAS  PubMed  Google Scholar 

  8. Heppenstall RB. Fracture treatment and healing. Eastbourne: Saunders; 1980. ISBN 978-0721646381.

  9. Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orth Rel Res. 1986;212:18–25.

    Google Scholar 

  10. Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000;14(5):335–8.

    Article  CAS  PubMed  Google Scholar 

  11. Park K, Kim K, Choi YS. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop. 2011;35(4):581–5.

    Article  PubMed  PubMed Central  Google Scholar 

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Conflict of interest

A. A. Dhawale and H. R. Jhunjhunwala declare that they have no conflict of interest.

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Correspondence to A. A. Dhawale.

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Jhunjhunwala, H.R., Dhawale, A.A. Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?. Eur J Trauma Emerg Surg 42, 339–343 (2016).

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