Abstract
Objective To retrospectively compare the outcomes between exchange reamed intramedullary nailing (ERN) and augmentation compression plating (ACP) combined with autogenous bone grafting in treatment of femoral shaft nonunion after intramedullary nailing. Methods A multicentre retrospective study was performed for 178 patients (180 sides) with femoral shaft nonunion after intrame-dullary nailing. Eighty-six (87 sides) out of the 178 patients underwent ERN (Group A) consisting of nonisthmal nonunions in 42 sides (48%) and isthmal nonunions in 45 sides (52%). The remaining 92 patients (93 sides) underwent ACP combined with autogenous bone grafting (Group B)consisting of nonisthmal nonunions in 46 sides (49%) and isthmal nonunions in 47 sides (51%). Comparative study was made on operation time, intraoperative blood loss, time to union, union rate, postoperative draining volume and complication rate. Results Mean follow-up was 4.1 years (range, 1-7.1 years). Union rate was 86% for Group A and 100% for Group B (OR=3. 28, 95%CI 0.8-14.0). In Group A re-nonunion was seen in 12 sides including nonisthmal nonunions in 10 sides (83%) and isthmal nonunion with cortical bone defect>3 cm in 2 sides (17%). Group A reported higher values in time to union, intraoperative blood loss as well as complication rate and lower healing rate over Group B(P 0.05). However, for nonisthmal nonunions, operation time was (127.3±21.7)min in Group A versus (89.9±14.1)min in Group B (P<0.05). Conclusions In contrast, ACP combined with autogenous bone grafting results in shorter time to union and higher bone union rate during the treatment of femoral shaft nonunion after failed intramedullary nailing. Especially for nonisthmal or isthmal femoral shaft nonunions with larger bone defect, ACP combined with autogenous bone grafting brings relatively more advantages. Key words: Femoral fractures; Fractures, ununited; Intramedullary nailing
Published Version
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