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Double locking plate fixation for femoral shaft nonunion

  • Original Article • LOWER LIMB - FRACTURES
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Abstract

Introduction

Nonunions after operative fixation of the femur, although infrequent, remain a challenge for orthopedic surgeons. The aim of this study was to assess the effectiveness of double locking plate fixation in the treatment for femoral shaft nonunions.

Materials and methods

From 2009 to 2013, 21 patients with femoral nonunions (mean age 46.9 years, range 25–81) were treated and evaluated utilizing double locking plate fixation. Patients were followed for at least 6 months postoperatively or until they achieved complete union to investigate bone healing and functional outcomes in femoral shaft nonunions treated with double locking plate and autogenous cancellous bone graft.

Results

The main outcomes evaluated were the presence of bony union, time to achieve union, and SF-36 score. All 21 femoral nonunions healed (100 % union rate). The average time to bony union was 5.3 months (range, 4–7). The mean follow-up duration time was 24.8 months (range, 6–60). Average scores of the physical function and bodily pain components of the SF-36 were 96 (range, 90–99) and 94.2 (range, 92–99), respectively. No significant complications were noted postoperatively.

Conclusion

Because of the high union rates and lack of significant complications in our series, double locking plate fixation can serve as an effective method of addressing femoral shaft nonunions. No significant complications were found postoperatively.

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References

  1. Babhulkar S, Pande K, Babhulkas S (2005) Nonunion of the diaphysis of long bones. Clin Orthop Relat Res 431:50

    Article  PubMed  Google Scholar 

  2. Mast JW, Teitge RA, Gowda M (1990) Preoperative planning for the treatment of nonunions and the correction of malunions of the long bones. Orthop Clin North Am 21:693

    CAS  PubMed  Google Scholar 

  3. Ebraheim NA, Martin A, Sochacki KR, Liu J (2013) Nonunion of distal femoral fractures: a systematic review. Orthop Surg 5(1):46–50

    Article  PubMed  Google Scholar 

  4. Patel VR, Menon DK, Pool RD, Simonis RB (2000) Nonunion of the humerus after failure of surgical treatment: management using the Ilizarov circular fixator. J Bone Joint Surg Br 82:977–983

    Article  CAS  PubMed  Google Scholar 

  5. Dujardyn J, Lammens J (2007) Treatment of delayed union or non-union of the tibial shaft with partial fibulectomy and an Ilizarov frame. Acta Orthop Belg 73(5):630–634

    PubMed  Google Scholar 

  6. Webb LX, Winquist RA, Hansen ST (1986) Intramedullary nailing and reaming for delayed union or non-union of the femoral shaft: a report of 105 consecutive cases. Clin Orthop 212:133–141

    PubMed  Google Scholar 

  7. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N (2003) Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury 34(5):349–356

    Article  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Finkemeier CG, Chapman MW (2002) Treatment of femoral diaphyseal nonunions. Clin Orthop Relat Res 398:223–234

    Article  PubMed  Google Scholar 

  10. Wu CC, Chen WJ (2002) Exchange nailing for aseptic nonunion of the femoral shaft. Int Orthop 26(2):80–84

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Bellabarba C, Ricci WM, Bolhofner BR (2001) Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing. J Orthop Trauma 15(4):254–263

    Article  CAS  PubMed  Google 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):178–182

    Article  CAS  PubMed  Google Scholar 

  13. 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):640–644

    Article  CAS  PubMed  Google 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):335–338

    Article  CAS  PubMed  Google Scholar 

  15. Wu CC, Chen WJ (1997) Treatment of femoral shaft aseptic nonunions: comparison between closed and open bone-grafting techniques. J Trauma 43(1):112–116

    Article  CAS  PubMed  Google Scholar 

  16. Hailer YD, Hoffmann R (2006) Management of a nonunion of the distal femur in osteoporotic bone with the internal fixation system LISS (less invasive stabilization system). Arch Orthop Trauma Surg 126(5):350–353

    Article  PubMed  Google Scholar 

  17. Bungaro P, Pascarella R, Colozza A, Zinghi GF (1999) Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur. Chir Organi Mov 84(3):263–267

    CAS  PubMed  Google Scholar 

  18. Webb LX, Winquist RA, 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 

  19. Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, MacDonald DA, Smith RM (1999) Exchange nailing for femoral shaft aseptic non-union. Injury 30(4):245–249

    Article  CAS  PubMed  Google Scholar 

  20. Yu CW, Wu CC, Chen WJ (2002) Aseptic nonunion of a femoral shaft treated using exchange nailing. Chang Gung Med J 25(9):591–598

    PubMed  Google Scholar 

  21. Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H (2009) Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics 32(6):409

    Article  PubMed  Google Scholar 

  22. 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):653–657

    Article  PubMed  Google Scholar 

  23. Naeem-ur-Razaq M, Qasim M, Sultan S (2010) Exchange nailing for non-union of femoral shaft fractures. J Ayub Med Coll Abbottabad 22(3):106–109

    PubMed  Google Scholar 

  24. Lin CJ, Chiang CC, Wu PK, Chen CF, Huang CK, Su AW, Chen WM, Liu CL, Chen TH (2012) Effectiveness of plate augmentation for femoral shaft nonunion after nailing. J Chin Med Assoc 75(8):396–401

    Article  PubMed  Google Scholar 

  25. Wang FD, Gao YZ, Yuan W, Du JQ, Wei XC (2014) Augmentative locking compression plate (LCP) combined with bone graft for the treatment of aseptic femoral shaft nonunion after intramedullary nailing. Zhongguo Gu Shang 27(10):815–818

    PubMed  Google Scholar 

  26. Maimaitiyiming A, Amat A, Rehei A, Tusongjiang M, Li C (2015) Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: a case series of 14 patients. Injury 46(6):1102–1107

    Article  PubMed  Google Scholar 

  27. Chiang JC, Johnson JE, Tarkin IS, Siska PA, Farrell DJ, Mormino MA (2016) Plate augmentation for femoral nonunion: more than just a salvage tool? Arch Orthop Trauma Surg 136(2):149–156

    Article  CAS  PubMed  Google Scholar 

  28. Murray WR, Lucas DB, Inman VT (1964) Treatment of non-union of fractures of the long bones by the two-plate method. J Bone Joint Surg Am 46:1027–1048

    CAS  PubMed  Google Scholar 

  29. Parker B (1974) Two-plate fixation in the treatment of the tibial shaft fracture and non-union. Injury 5(4):291–297

    CAS  PubMed  Google Scholar 

  30. Martinez AA, Cuenca J, Herrera A (2009) Two-plate fixation for humeral shaft non-unions. J Orthop Surg (Hong Kong) 17(2):135–138

    Google Scholar 

  31. Haverstock BD, Mandracchia VJ (1998) Cigarette smoking and bone healing: implications in foot and ankle surgery. J Foot Ankle Surg 37:69–74

    Article  CAS  PubMed  Google Scholar 

  32. Taylor JC (1992) Delayed union and nonunion of fractures. In: Crenshaw AH (ed) Campbell’s operative orthopaedics, 8th edn. St. Louis, Mosby, pp 1287–1345

    Google Scholar 

  33. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium-2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21(Suppl 10):1–133

    Article  Google Scholar 

  34. Keller SD, Bayliss MS, Ware JE Jr, Hsu MA, Damiano AM, Goss TF (1997) Comparison of responses to SF-36 health survey questions with one-week and four-week recall periods. Health Serv Res 32:367–384

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Esterhai JL Jr, Brighton CT, Heppenstall RB, Alavi A, Mandell GA (1984) Technetium and gallium scintigraphic evaluation of patients with long bone fracture nonunion. Orthop Clin North Am 15:125

    PubMed  Google Scholar 

  36. Lin SJ, Chen CL, Peng KT, Hsu WH (2014) Effect of fragmentary displacement and morphology in the treatment of comminuted femoral shaft fractures with an intramedullary nail. Injury 45(4):752–756

    Article  PubMed  Google Scholar 

  37. Boyd HB, Lipinski SW, Wiley JH (1961) Observations on nonunion of the shafts of the long bones, with a statistical analysis of 842 patients. J Bone Joint Surg 43:159–168

    Google Scholar 

  38. Crowley DJ, Kanakaris NK, Giannoudis PV (2007) Femoral diaphyseal aseptic non-unions: is there an ideal method of treatment? Injury 385:555–563

    Google Scholar 

  39. Court-Brown CM, Keating JF, Christie J, McQueen MM (1995) Exchange intramedullary nailing: its use in aseptic tibial non-union. J Bone Joint Surg Br 77B:407–411

    Google Scholar 

  40. Campbell WC (1939) The autogenous bone graft. J Bone Joint Surg 21:694

    Google Scholar 

  41. Johnson EE, Urist MR (2000) Human bone morphogenetic protein allografting for reconstruction of femoral nonunion. Clin Orthop Relat Res 371:61

    Article  PubMed  Google Scholar 

  42. Bucholz RW, Carlton A, Holmes R (1989) Interporous hydroxyapatite as a bone graft substitute in tibial plateau fractures. Clin Orthop Relat Res 240:53

    PubMed  Google Scholar 

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Author notes

    Authors and Affiliations

    1. Department of Orthopaedic Surgery, General Hospital of Chinese People’s Liberation Army, 28 Fu-Xing Road, Beijing, 100853, People’s Republic of China

      Ye Peng, Xinran Ji, Lihai Zhang & Peifu Tang

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    1. Ye Peng
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    2. Xinran Ji
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    3. Lihai Zhang
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    4. Peifu Tang
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    Correspondence to Lihai Zhang or Peifu Tang.

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    The authors declare that they have no conflict of interest.

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    Ye Peng and Xinran Ji have contributed equally to this work.

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    Peng, Y., Ji, X., Zhang, L. et al. Double locking plate fixation for femoral shaft nonunion. Eur J Orthop Surg Traumatol 26, 501–507 (2016). https://doi.org/10.1007/s00590-016-1765-z

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