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Exchange nailing with enhanced distal fixation is effective for the treatment of infraisthmal femoral nonunions

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The treatment options for nonunions of infraisthmal femoral shaft fractures after internal fixation are controversial. Methods such as exchanging an existing nail with a nail of a larger size, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. Among those options, exchange nailing seems to be the most popular choice. In this study, a Poller screw, or an additional interlocking screw, was used in conjunction with exchange intramedullary nailing. The purpose of this study was to evaluate the effectiveness of treating femoral shaft nonunions using insertion of a Poller screw or an additional interlocking screw in conjunction with intramedullary nail fixation.

Materials and methods

This study included 18 patients who presented with nonunion of femur shaft fractures after internal fixation at the infraisthmal level. These patients included 13 men and 5 women, with a mean age of 46.8 years (range 15–78 years). The mean postsurgical period of nonunion was 7.8 months (range 6–12 months). The patients were classified into two groups: the atrophic nonunion group and the hypertrophic nonunion group. In all patients, nailing was enhanced with a Poller screw or additional interlocking screws. All patients were followed up with plain film examinations and were assessed for their functional recovery status to determine the osseous union conditions.

Results

All 18 patients achieved postoperative bony union after a mean time of 7.5 months (range 3–12 months), and all patients were able to walk with full weight-bearing and without pain within 3 months. There were no significant complications, such as broken hardware, implant back-outs, axial or rotational malalignments, or deep infections.

Conclusion

Poller screws and additional interlocking screws, along with intramedullary nailing exchange, may be an effective and reliable alternative for treating infraisthmal femoral shaft nonunions.

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Author notes

  1. Yong-Cheol Yoon and Jong-Keon Oh contributed equally to the present work.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Kyungpook National University Hospital, 50, 2-ga, Samdok, Chung-gu, Daegu, 700-721, Korea

    Joon-Woo Kim & Chang-Wug Oh

  2. Orthopedic Trauma Division, Trauma Center, Gachon University Gil Hospital, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 405-760, Korea

    Yong-Cheol Yoon

  3. Department of Orthopaedic Surgery, Korea University College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul, 136-705, Korea

    Seung-Beom Han

  4. Department of Orthopaedic Surgery, Gachon University Gil Hospital, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 405-760, Korea

    Jae-Ang Sim

  5. Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul, 152-703, Korea

    Jong-Keon Oh

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  1. Joon-Woo Kim
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Correspondence to Yong-Cheol Yoon or Jong-Keon Oh.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Kim, JW., Yoon, YC., Oh, CW. et al. Exchange nailing with enhanced distal fixation is effective for the treatment of infraisthmal femoral nonunions. Arch Orthop Trauma Surg 138, 27–34 (2018). https://doi.org/10.1007/s00402-017-2802-z

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  • DOI: https://doi.org/10.1007/s00402-017-2802-z

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