Revision surgery for femoral shaft aseptic nonunion associated with broken distal locked screws

Abstract

Abstract Purpose This retrospective study was to report the experience in treating femoral shaft aseptic nonunions associated with breakage of distal locked screws. Materials and Methods Thirty-two femoral shaft aseptic nonunions associated with breakage of both distal locked screws in 30 consecutive adult patients with 32 nonunions were treated. Eleven nonunions were concomitantly associated with at least 1.5 cm (1.5–3.5) shortening. These 11 nonunions were treated by one-stage nail exchange and femoral lengthening, static locked nailing stabilization, and corticocancellous bone graft supplementation, whereas other 21 nonunions were treated with less than 1.5 cm shortening, simple exchange nailing only. Results Twenty-eight nonunions were followed-up for a median of 3.8 (1.1–6.2) years and 26 fractures healed at a median of 4 (3–9) months. Either group had one persistent nonunion (p = 0.48) and was successfully treated with repeated exchange nailing or open cancellous bone grafting. Conclusions Using exchange locked nailing or one-stage femoral lengthening to treat femoral shaft aseptic nonunion associated with broken distal locked screws can achieve a high success rate. The key of the technique to remove broken screws is withdrawing the nail a little bit to release the incarcerated broken screw end. Then, the screw end is pushed out with a used Knowles’ pin or a smaller size screwdriver under the image intensifier guidance.