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Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing

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We assessed indications and outcomes of exchange nailing and augmentation plating for femoral shaft nonunion following femoral nail failure.


We retrospectively reviewed the records of 21 consecutive patients with femoral shaft nonunion treated with femoral nailing from August 2008 to June 2013. Nonunion cases with infection were excluded from this study. The study population consisted of nine men and 12 women, with an average age of 40 (range 21–61) years. All patients received internal fixation using exchange nailing and an augment plate coupled with decortication and bone graft.


All patients in our study obtained osseous union with a mean time of six (range four to12) months. Mean operation time was three hours (range two to five hours), and mean blood loss was 800 ml (range 500–950 ml). There were no postoperative complications. At the last follow-up, all patients could flex their knees > 110°.


Exchange nailing and augment plating coupled with decortication and bone graft is an effective treatment option for femoral shaft nonunion and has more indications and higher union rate than the popular exchange nailing treatment.

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  1. Winquist RA, Hansen ST Jr, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 66:529–39

    PubMed  CAS  Google Scholar 

  2. Wolinsky PR, McCarty E, Shyr Y, Johnson K (1999) Reamed intramedullary nailing of the femur: 551 cases. J Trauma 46:392–339

    Article  PubMed  CAS  Google Scholar 

  3. Pihlajamaki HK, Salminen ST, Bostman OM (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 16:394–402

    Article  PubMed  Google Scholar 

  4. Brinker MR, O’Connor DP (2007) Exchange nailing of ununited fractures. J Bone Joint Surg Am 89:177–188

    Article  PubMed  Google Scholar 

  5. 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 Tranuma 14:335–338

    Article  CAS  Google Scholar 

  6. Banazkiewicz PA, Sabboubeh A, McLeod I, Maffulli N (2003) Femoral exchange nailing for aseptic non-union :not the end to all problems. Injury 34:349–356

    Article  Google Scholar 

  7. Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, Macdonald DA, Smith RM (1999) Exchange nailing for femoral shaft aseptic non-union. Injury 30:245–249

    Article  PubMed  CAS  Google Scholar 

  8. Hak DJ, Lee SS, Goulet JA (2000) Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma 14:178–182

    Article  PubMed  CAS  Google Scholar 

  9. Wu CC, Chen WJ (2002) Exchange nailing for aseptic nonunion of the femoral shaft. Int Orthop 26:80–84

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  10. LaVelle DG (2003) Delayed union and nonunion of fractures. In: Canale ST (ed) Campbell’s operative orthopedics, vol 2, 10th edn. Mosby, Philadelphia, pp 3125–3165

    Google Scholar 

  11. Starr AJ, Bucholz RW (2001) Fractures of the shaft of the femur. In: Bucholz RW, Heckman JD (eds) Rockwood and Green’s fractures in adult, vol 2, 5th edn. Lippincott Williams & Wilkins, Philadelphia, pp 1683–1730

    Google Scholar 

  12. Webb LX, Winquist PA, Hansen ST (1986) Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft: a report of 105 consecutive cases. Clin Orthop Relat Res 212:133–141

    PubMed  Google Scholar 

  13. Mercado EM, Lim EV, Stern PJ, Aquino NJ (2001) Exchange nailing for failure of initially rodded tibial shaft fractures. Orthopedics 24:757–762

    PubMed  CAS  Google Scholar 

  14. Ueng SW, Shih CH (1998) Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma 45:747–752

    Article  PubMed  CAS  Google Scholar 

  15. Niedzwiedzki T, Brudnicki J, Niedzwiedzki L (2007) Treatment of femoral shaft union disturbances with intramedullary nailing. Treatment failure. J Ortop Traumatol Rehabil 9:377–383

    Google Scholar 

  16. Kyu Hyun Y, Jung Ryul K, Park J (2012) Nonisthmal femoral shaft nonunion as a risk for exchange nailing failure. J Trauma 72:60–64

    Google Scholar 

  17. Nadkarni B, Srivastav S, Mittal V, Aqarwal S (2008) Use of locking compression plates for long bone non-unions without removing existing intramedullary nail: review of literature and our experience. J Trauma 65(2):482–486

    Article  PubMed  Google Scholar 

  18. Brijandinejad A, Ebrahimzadeh MH, Chabock HA (2009) Augmentation plate fixation for treatment of femoral and tibial nonunions after intramedullary nailing. J Orthopaedics 32(6):409

    Article  Google Scholar 

  19. Park J, Kim SG, Yoon HK, Yang KH (2010) The Treatment of nonisthmal femoral Shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma 24(2):89–94

    Article  PubMed  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  21. 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):287–290

    CAS  Google Scholar 

  22. Ye J, Zhen Q (2012) Augmentative locking compression plate fixation for the management of long bone nonunion after intramedullary nailing. Arch Orthop Trauma Surg 321:937–940

    Article  Google Scholar 

  23. Park J, Yang KH (2013) Indications and outcomes of augmentation plating with decortication and autogenous bone grafting for femoral shaft nonunions. Injury 44(12):1820–5

    Article  PubMed  Google Scholar 

  24. 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):84–9

    Article  PubMed  Google Scholar 

  25. Mohammad Naeem-ur-Razaq,Muhammad Qasim,Shahid Sultan.Exchange naling for nonunion of femoral shaft fractures.J Ayub Med Coll Abbottabad 2010;22(3).Ao:AO classification

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Correspondence to Jinlian Liu.

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Wang, Z., Liu, C., Liu, C. et al. Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing. International Orthopaedics (SICOT) 38, 2343–2347 (2014).

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