Intramedullary Nailing for the Treatment of Femoral Non-Unions Following Multiple Failed Plate Fixations

Abstract

Goal: The evaluation of the clinical outcome of IM nailing for the treatment of femoral shaft pseudarthrosis in patients who had multiple failed plate osteosyntheses. Method: From January 2000 till March 2002, 18 (17 male and 1 female, mean age 37 years) patients were treated because of femoral shaft non-union in our institution. All patients had two or more failed plate osteosyntheses. There were no septic non-unions in this group. There was no segmental bone loss. In all 18 patients the implants were removed and intramedullary nailing was performed. There was extensive periosteal stripping and areas of osteonecrosis in the majority of the patients. The quality of the surrounding soft tissues was poor due to scaring. Eight femurs were grafted with autologous iliac crest bone graft. All patients were followed by serial X-rays until union. Results: There were no postoperative complications. All pseudarthroses were healed within an average of 10.7 months (6 -14). Non-unions which received bone graft (8 out of 18) in day one, were healed faster than those which didn't. There was no re-operations among these patients. Among the remaining 10 patients 6 were grafted five to six months postoperatively and three had had nail dynamization. Conclusions: Intramedullary nailing for femoral shaft non-unions after multiple failed plate osteosyntheses is a safe and effective method of treatment. It seems that autologous bone graft reduces healing time and re-operation rate.