Individualized treatment of aseptic femoral nonunion after intramedullary nailing

Abstract

Objective To evaluate individualized treatment of aseptic femoral nonunion after interlocking intramedullary nailing based on the morphology of each nonunion and nailing stability in each specific patient. Methods This study reviewed 108 patients who had been treated and followed up for more than one year for aseptic femoral nonunion following interlocking intramedullary nailing between February 2012 and February 2016. They were 89 men and 19 women, aged from 23 to 65 years (average, 45.5 years). The classification and corresponding treatments were as follows: Type Ⅰ (15 cases), characterized by callus (+)/bone defect (-) and nailing stability (+), were treated by augmentation plating; Type Ⅱ (43 cases), characterized by callus (+)/bone defect (-) and nailing stability (-), were treated by exchange for larger nailing/larger nailing with poller screws; Type Ⅲ (23 cases), characterized by callus (-)/bone defect (+) and stability of nailing (+), were treated by augmentation plating with bone grafting; Type IV (27 cases), characterized by callus (-)/bone defect (+) and stability of nailing(-), were treated by double plating and bone grafting. The healing of bone nonunion, complications and assessments for bone and function were followed up. Results All these patients received follow-up for 12 to 14 months (average, 12.5 months). All the nonunions were healed with no postoperative complications. Bone healing was achieved after 4 to 8 months (average, 5.5 months). The good to excellent rates for bone and function were 100%. Conclusion To achieve better surgical outcomes, the treatment of aseptic femoral nonunion after interlocking intramedullary nailing should be individualized according to the morphology of each nonunion and nailing stability in each specific patient. Key words: Femur; Fractures, ununited; Bone nails