Abstract
BackgroundThe aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures.MethodsBetween 2003 and 2010, 72 consecutive patients with nonunion of the femoral shaft were operated using a standardized protocol in our trauma department and followed up for successful union and functional result.ResultsOsseous healing was observed in 71 patients (98%). Only one patient was lacking bone healing following a time period of 24 months after the first exchange nailing and 5 months after the second exchange nailing. In 59 patients (82%), uneventful and timely bone healing after exchange nailing was detected. In 18% of patients (n = 13), delayed bone healing was observed and required additional therapy. In the majority of patients (61%), bone healing occurred within the first 2 to 5 months, only 18% of patients’ duration of bone healing exceeded 8 months. In 62 patients (86%), no relevant or clinically apparent leg-length discrepancy prior to and after exchange nailing was detected as well as no significant axis deviation or malrotation. Functional studies including simple clinical gait and standing analysis, return to activities of daily life, return to sports activities, and return to work were all reached on a satisfying level.DiscussionReamed intramedullary exchange nailing as described in this study is the treatment of choice for aseptic femoral shaft nonunion with a high rate of bone healing and a low rate of complications including length discrepancy or malrotation and a good functional outcome.
Highlights
The aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures
Exchange nailing remains the treatment of choice for aseptic, non-comminuted nonunion of the femoral diaphysis following primary intramedullary nailing [8,9,10,11]
A prospective case series was performed, and all patients were included in this study who had been treated with intramedullary nailing of a femoral shaft fracture and had developed femoral shaft nonunion
Summary
The aim of this study was to evaluate a standardized method of treatment of femoral nonunion of the isthmal femur excluding non-united metaphyseal fractures. For fractures of the femoral shaft, operative treatment is generally recommended, and intramedullary nailing is considered the treatment of choice [1,2,3,4]. Union rates are reported to be as high as 85%–100% [1,2,3,4], nonunion does occur mostly in the form of aseptic hypertrophic nonunion. The management of these non-united femoral shaft fractures or According to the literature, exchange nailing remains the treatment of choice for aseptic, non-comminuted nonunion of the femoral diaphysis following primary intramedullary nailing [8,9,10,11]. Open application of autologous bone grafting usually is not required, but internal bone grafting by the reaming material is successfully utilized for stimulation of osteogenesis [12,13]
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