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Isthmic or Non-isthmic Femoral Nonunion After IM Nailing

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The Art of Intramedullary Nailing for Femoral Fracture

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Abstract

Most surgeons agree that IM nailing is the treatment of choice for femoral shaft fracture. The union rates of IM femoral nailing range from 97% to 99.1%. The introduction of interlocked nailing has decreased the risk of shortening after nailing, but some limited cases have still been complicated with nonunion after IM nailing. The main mechanical problem that causes nonunion in the interlocked IM nailing system is rotational instability. Exchange nailing is an excellent choice for aseptic nonunions of noncomminuted diaphyseal femoral fractures, with union rates reported to range from 72% to 100%. The location of nonunion is an important factor in exchange femoral nailing. History of comminuted and open fracture are other risk factors of exchange nailing.

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References

  1. 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.

    Article  CAS  PubMed  Google Scholar 

  2. Kempf I, Grosse A, Abalo C. Locked intramedullary nailing. Its application to femoral and tibial axial, rotational, lengthening, and shortening osteotomies. Clin Orthop Relat Res. 1986;212:165–73.

    Article  Google Scholar 

  3. Nork SE. Femoral shaft fracture. In: Court-Brown CM, et al., editors. Rockwood and Green’s fractures in adult. 8 th ed. Philadelphia: Wolters Kluwer; 2015. p. 2149–228.

    Google Scholar 

  4. Winquist RA, Hansen ST Jr, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am. 1984;66(4):529–39.

    Article  CAS  PubMed  Google Scholar 

  5. Wiss DA, Brien WW, Stetson WB. Interlocked nailing for the treatment of segmental fractures of the femur. J Bone Joint Surg Am. 1990;72:724–8.

    Article  CAS  PubMed  Google Scholar 

  6. Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, MacDonald DA, Smith RM. Exchange nailing for femoral shaft aseptic non-union. Injury. 1999;30(4):245–9.

    Article  CAS  PubMed  Google Scholar 

  7. Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000;14(3):178–82.

    Article  CAS  PubMed  Google Scholar 

  8. Pihlajamäki HK, Salminen ST, Böstman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma. 2002;16(6):394–402.

    Article  PubMed  Google Scholar 

  9. Swanson EA, Garrard EC, Bernstein DT, DP OC, Brinker MR. Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma. 2015;29(1):21–7.

    Article  PubMed  Google Scholar 

  10. Tsang ST, Mills LA, Baren J, Frantzias J, Keating JF, Simpson AH. Exchange nailing for femoral diaphyseal fracture non-unions: risk factors for failure. Injury. 2015;46(12):2404–9.

    Article  CAS  PubMed  Google Scholar 

  11. Park J, Kim SG, Yoon HK. Yang KH the treatment of nonisthmal femoral shaft nonunions with IM nail exchange versus augmentation plating. J Orthop Trauma. 2010;24:89–94.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  13. Yang KH, Kim JR, Park J. Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure. J Trauma. 2012;72:E60–E4.

    Google Scholar 

  14. Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997;43:640–4.

    Article  CAS  PubMed  Google Scholar 

  15. Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma. 1998;45:747–52.

    Article  CAS  PubMed  Google Scholar 

  16. Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop. 2005;29:287–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Krettek C, Stephan C, Schandelmaier P, Richter M, Pape HC, Miclau T. The use of Poller screws as blocking screws in stabilising tibial fractures treated with small diameter intramedullary nails. J Bone Jt Surg Br. 1999;81:963–8.

    Article  CAS  Google Scholar 

  18. Huang KC, Tong KM, Lin YM, Loh el W, Hsu CE. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury. 2012;43(10):1747–52.

    Article  PubMed  Google Scholar 

  19. Perumal R, Shankar V, Basha R, Jayaramaraju D, Rajasekaran S. Is nail dynamization beneficial after twelve weeks–an analysis of 37 cases. J Clin Orthop Trauma. 2018;9(4):322–6.

    Article  PubMed  Google Scholar 

  20. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg Am. 2007;89:177–88.

    Article  PubMed  Google Scholar 

  21. Wu CC, Chen WJ. Exchange nailing for aseptic nonunion of the femoral shaft. Int Orthop. 2002;26(2):80–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Vaughn J, Gotha H, Cohen E, Fantry AJ, Feller RJ, Van Meter J, Hayda R, Born CT. Nail dynamization for delayed union and nonunion in femur and tibia fractures. Orthopedics. 2016;39(6):e1117–e23.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Armed Forces Capital Hospital, Seongnam, Republic of Korea

    Kyu Hyun Yang

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  1. Kyu Hyun Yang
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Correspondence to Kyu Hyun Yang .

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Yang, K.H. (2022). Isthmic or Non-isthmic Femoral Nonunion After IM Nailing. In: The Art of Intramedullary Nailing for Femoral Fracture. Springer, Singapore. https://doi.org/10.1007/978-981-19-3730-9_10

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  • DOI: https://doi.org/10.1007/978-981-19-3730-9_10

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-19-3729-3

  • Online ISBN: 978-981-19-3730-9

  • eBook Packages: MedicineMedicine (R0)

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