Nonunited Fractures Research Articles

Valgus Osteotomy for Non-Union Fracture Neck of Femur in a Child: A Case Report

Paediatric neck of femur fractures is rare and incorporates less than 1% of all the paediatric fractures. Complications of femoral neck fractures in children includes necrosis (AVN) of femoral head, non-union and premature closure of the proximal femoral physis— resulting in decrease of growth, coxa vara and limb-length discrepancies. In past, the incidence of non-union varied from 7% to 10%, depending on the location of the fracture in the neck of femur the incidence of non-union in these fractures have significantly reduced in the recent times due to early anatomical reduction and rigid internal fixation. Due to the small number of cases, the treatment protocols for non-union of the paediatric femoral neck fractures are not well defined. Valgus osteotomy changes the shearing force at the non-union site to compression forces which provides optimal environment for bone union. Here we present a case of 6 years old child who presented with non-united fracture of the neck of femur with coxa vara, 1 year after conservatively treated osteomyelitis of proximal femur with valgus intertrochanteric osteotomy.

Evaluation of treatment of nonunited middle third scaphoid fractures using threaded Kirschner wires fixation with iliac bone grafting

Abstract Objectives To evaluate the results of iliac bone grafting with threaded Kirschner wires (K-wires) fixation in treating of nonunited middle third scaphoid fractures. Background Scaphoid nonunion is a common complication after scaphoid fractures as it is an intra-articular fracture with high fracture mobility and instability. In addition, the scaphoid is devoid of periosteum along with impaired vascularity. Scaphoid nonunion results in carpal collapse with secondary osteoarthritis. To avoid that, the aim of treatment should be to enhance the biology of fracture through bone grafting and provide adequate stability of the fracture in an anatomic alignment. Patients and methods This study is a prospective case series of 30 patients with nonunited middle third scaphoid fractures admitted to an academically supervised trauma center from June 2018 to June 2020. They were managed by open reduction, refreshment of the scaphoid nonunion site with iliac crest bone grafting, and threaded K-wires fixation in an anatomical alignment. The mean age was 28.58 ± 4.47 years. Postoperative clinical outcomes were evaluated using the Quick disabilities of arm, shoulder and hand (DASH) score, and modified Mayo wrist score. Postoperative radiological union and scaphoid alignment were assessed. The minimum period of follow-up was one year. Results One year postoperatively, the mean modified Mayo wrist score was 81.67 ± 9.39 and the mean Quick DASH score was 25.67 ± 14.97. Radiologically, the union was achieved in 86.7%. The mean union time was 11.92 ± 1.54 weeks. Conclusions Threaded K-wires fixation with iliac bone grafting is an effective method for treating nonunited middle third scaphoid fractures.

Correction of cubitus valgus and reconstruction of lateral humerus condylar defect using tricortical iliac graft in pediatric patients.

Neglected non-united lateral humeral condyle fractures in pediatrics are a probable cause of cubitus valgus deformity which is a disabling complication. The ideal management for this condition is still debatable. This study aimed to evaluate the reconstruction of a non-united lateral humerus condylar fracture complicated by cubitus valgus using a tricortical iliac crest graft in pediatric patients. Twenty children suffering from cubitus valgus as a complication after a non-united fracture of the lateral humeral condyle were included in this study. They were managed by open reduction, screw fixation, and reconstruction by an autologous tricortical iliac bone graft. We compared the preoperative and postoperative range of motion of the elbow, alignment, and elbow function using the Mayo elbow performance index. There was a statistically significant improvement in the elbow range of motion postoperatively, and there was a highly significant improvement regarding the elbow alignment and function. Open reduction, screw fixation, and reconstruction by the autologous tricortical iliac bone graft is an effective technique for the management of cubitus valgus due to neglected non-united lateral humeral condyle fractures in pediatrics.

Augmentation plates and bone grafting for treatment of nonunited long bones fractures fixed by intramedullary nails

Abstract Background A delayed union was defined as when the fracture fails to unite within the expected time. Delayed union becomes nonunion when the fracture healing stops (at least 6 months). Intramedullary nailing has proven to be a good treatment option in the management of long bones fracture. The aim of this study is to obtain union in nonunited long bones fractures fixed previously by intramedullary nails by using of augmentation plating and bone grafting to obtain the best outcome. Patients and methods The study included 18 patients of nonunited long bones fractures fixed previously by intramedullary nails treated with augmentation plating and bone grafting with maintaining the nail in situ. Full history, clinical and radiological examination were performed. All subjects gave their informed consent prior to their inclusion in the study. Eight cases with femoral fracture nonunion were performed through the lateral approach of the femur. Seven cases of tibial fracture nonunion were performed through the anterior approach of the tibia, Three cases of humeral nonunion was performed using the posterior approach of the humerus. In the postoperatively follow-up, function was assessed using Dash score and Lower extremity functional score. Results There was an excellent improvement for bone union occurred to 94.4% of studied patients. Furthermore lower extremities function percent ranged between 92.5-100 with mean±SD 98.1 ± 2.56, and humerus Dash score ranged between 4.16-6.66 with mean±SD 5.41 ± 1.77. There was statistically insignificant difference between the period of nonunion bone per months and fracture bone criteria of studied patients P>0.05. Also, there is statistically insignificant difference between lower extremities function score percent after implant procedure and fracture bone criteria of studied patients P > 0.05. Conclusion Augmentation plating is an excellent solution for the management of nonunited nailed long bones fractures with maintaining the nail in situ, especially with instability at nonunion site and comminution or gap nonunion.

Plate over nail and bone graft for management of tibial non union after intramedullary fixation

Abstract Non union after intramedullary nail fixation is difficult to treat. Many options are available for its management including nail exchange, bone graft while keeping the nail, nail removal and plating. Each method has its advantages and disadvantages. The aim of this study is to evaluate the results of management of tibial non union after intramedullary fixation using plate augmentation. Between January 2012 and December 2019, thirty four patients with nonunited fracture tibia previously treated with locked intramedullary nails were included in this study. The ages of patients ranged from 20 to 62 years ( an average age: 43 years). All patients were diagnosed to have aseptic nonunion. All patients achived bony union except 2. Bone union was achieved in a time ranged from 3 to 9 months (an average time 5 months). The average limb length discrepancy was 1 cm ( range 0 to 1.5 cm ). The reported complications were superficial wound infection in 2 cases, joint stiffness in 3 patients and nonunion in 2 cases. There were no intraoperative complications. All patients reported no pain at the fracture site during weight bearing at the final follow-up. We concluded that augmentation plate fixation is a good option for treatment of tibial nonunion after intramedullary nail.

Management of Infected Femoral Nonunion by Arched External Fixator Augmented by Flexible Intramedullary Nails

Abstract Purpose: The aim of this study is to evaluate the functional and radiological outcome of the management of infected femoral nonunion by arched frame augmented by flexible intramedullary nails. Patients and Methods: In this retrospective case series study, 20 cases were included. All patients had chronically infected nonunited fracture femur. The mean age of the included patients was 33 years. The site of the femoral fracture was midshaft in 12 patients, proximal third of femur in 6 patients, and distal third in 2 cases. Initially, the fracture was open in 17 patients and closed in 3 patients. Four of the included patients had diabetes mellitus. Ten cases were smokers and six of them were heavy smokers. All cases were managed by arched frames, augmented by flexible intramedullary nails. Functional and radiological evaluation was performed using the Association for the Study and Application of the Methods of Ilizarov (ASAMI) scoring system. Results: The mean follow-up was 18.45 months. All cases achieved union except two cases (10%). According to ASAMI bony score, 11 patients (55%) were excellent, 6 (30%) were good, 1 was fair (5%), and 2 (10%) showed poor results. According to ASAMI functional score, 3 patients were excellent, 15 (75%) were good, 3 (15%) were fair, and 2 (10%) showed poor results. Conclusion: The management of infected nonunion of the femur by arched frame and intramedullary flexible nails provides a stable fixation, with acceptable functional and radiological results. Level of Evidence: Level IV case series study.

Arthroscopic Excision for Painful Acromial Fracture Nonunion After Reverse Total Shoulder Replacement

Acromial stress fracture is a well-known complication after reverse shoulder arthroplasty. Although some patients are asymptomatic, others may present with reproducible pain to palpation and signs of impingement. Generally, the initial mode of treatment is conservative; however, surgical intervention is considered in patients with painful nonunion and displaced fragments. Although open reduction techniques are most common, Levy type I fragments may be amenable to excision. This technical note provides a stepwise approach to arthroscopic excision for painful nonunited acromial stress fractures after reverse shoulder arthroplasty.

Posttreatment Imaging of the Wrist and Hand: Update 2022.

Common indications for surgical procedures of the wrist and hand include acute fractures or fracture-dislocations; nonunited fractures; posttraumatic, degenerative, and inflammatory arthritides and tendinopathies; injuries to tendons, ligaments, and the triangular fibrocartilage complex; and entrapment neuropathies. Soft tissue or osseous infections or masses may also need surgical treatment. Several of these procedures require surgical hardware placement, and most entail clinical follow-up with periodic imaging. Radiography should be the first imaging modality in the evaluation of the postoperative wrist and hand. Computed tomography, magnetic resonance imaging, diagnostic ultrasonography, and occasionally nuclear medicine studies may be performed to diagnose or better characterize suspected postoperative complications. To provide adequate evaluation of postoperative imaging of the wrist and hand, the interpreting radiologist must be familiar with the basic principles of these surgical procedures and both the imaging appearance of normal postoperative findings as well as the potential complications.

Fixator-Assisted Nailing for Femur Neck Fracture Nonunion: A Case Series Study.

Background Femoral neck fractures in young adults tend to be a result of high-energy trauma with a common pattern of Pauwels type III fracture, and they require timely and meticulous diagnosis and management. The objective of this study was to assess the clinical and radiological outcomes of the fixator-assisted nailing technique for managing femur neck fracture nonunion. Methods. This was a case series study of 16 patients with nonunion femoral neck fractures treated via a fixator-assisted nailing technique. Our inclusion criteria comprised the inclusion of any patient between the ages of 14 and 60 years old with a neglected neck of femur fracture or nonunion of the femur neck. In addition, we only included patients without further posttreatment trauma and without known metabolic diseases. The conditions that were excluded from this study included hip joints with preexisting osteoarthritis, radiographic evidence of avascular necrosis of the femoral head, and associated ipsilateral acetabulum fracture or fracture-dislocation. The fracture characteristics that were selected for the fixator-assisted nailing (FAN) technique were clear signs of pseudoarthrosis (such as sclerosis, clear fracture line defects, and failure of implants), in addition to evidence of varus malalignment. All fractures were Pauwels type III. Radiographs of the pelvis with both hips and a posteroanterior (PA) view of the injured hip were taken. Full weight bearing was allowed in all the patients from the first day postoperatively. Physical therapy was started for pain reduction modalities, stretching, and abductor strengthening. Results Union of the femur neck fracture and osteotomy site was achieved in all patients. An excellent functional status after four months of follow-up was found based on a modified Harris hip score questionnaire. At follow-up, no patient was suffering from pain or flexion contracture. Preoperative limb length discrepancy (LLD) (cm) was 1.8 ± 0.8 cm and postoperative was 0 ± 0.1 cm, p < 0.001. Preoperative neck-shaft angle (NSA) (o) was 85.6 ± 4.4 and postoperative was 126.9 ± 2.5, p < 0.001. Preoperative Pauwels angle (o) was an average of 50.4 ± 5.9 and postoperative was 31.3 ± 2.5, p < 0.001. Conclusion Our study indicates that FAN has a high success rate in young patients with nonunited femoral neck fractures.

Хирургическая тактика при лечении пациентов с последствиями внутрисуставных повреждений дистального отдела костей голени (обзор литературы)

Background Management of patients with sequelae of intra-articular fractures of the distal tibia continues to be a substantial clinical challenge in orthopaedic trauma due to the high incidence, poor outcomes and high disability rate. The objective was to review Russian and international experience in repair of intra-articular ankle fractures and explore contemporary trends in treatment strategies. Material and methods The literature search was produced using medical electronic databases of eLibrary, PubMed, Medline, SpringerLink between 2000 and 2020 and keywords: cruzarthrosis, arthrodesis, total ankle arthroplasty, arthroscopy, distal tibia, ankle joint, joint replacement, intra-articular fractures of distal tibial. Results The article presents an insight into the problem of malunited and nonunited ankle fractures, ankle contractures and deformities, post-traumatic ankle arthritis. Major surgical techniques used to address sequelae of ankle fractures include correcting osteotomy, arthroscopy, distraction arthroplasty, arthrodesis, total ankle arthroplasty with the advantages and disadvantages with each of the practices. Discussion The surgical option would depend on the time of injury, condition of soft and bone tissue, malalignment and severity of ankle arthritis. Joint saving procedures of correcting osteotomy, arthroscopy or distraction arthroplasty can be applied at early stages of the disease, and arthrodesis or total ankle arthroplasty are secured for terminal stages of ankle arthritis. Benefits of total ankle arthroplasty include preservation and improvement of ankle mobility, a short inpatient period. Ankle fusion is associated with less complication rate and low costs. Conclusion There is an obvious need for a uniform treatment algorithm with specific indications and contraindications to each surgical option.

The use of an external transosseous fixation device for non-united fractures and false joints of long bones after intramedullary osteosynthesis with a pin

In 40 patients with 44 ununited intramedullar osteosynthesis diaphysial fractures of long bones (humerus, radius, ulna, femur, tibia) the external transosseous fixation device was applied to the bone fragments without removal of rods from bone marrow canal. In that case the rod excluded horizontal and angle mobility of fragments and the device eliminated rotation mobility and created mutual pressure offragments. Consolidation of the fracture and function restoration were achieved in 42 cases. Two patients required bone plasty.

Наружный чрескостный остеосинтез при лечении внесуставных переломов костей голени: показания, осложнения, результаты применения

Введение. Выбор оптимальной методики остеосинтеза внесуставных переломов большеберцовой кости продолжает обсуждаться в научной литературе. При открытых переломах, высокоэнергетической травме, повреждениях мягких тканей, особенно в нижней трети голени, нередко используется метод наружной фиксации. Отказ от более широкого его применения объясняется опасениями воспалительных осложнений и неудобствами для больного. Цель исследования: анализ опыта применения наружного чрес­костного остеосинтеза при внесуставных переломах костей голени и обоснование показаний к его использованию. Материалы и методы. Проведен ретроспективный анализ лечения 67 пострадавших с внесуставными переломами большеберцовой кости методом наружного остеосинтеза. Изучены осложнения и результаты лечения. Проанализированы показания к применению, при которых преимущества метода превосходят неудобства, связанные с наличием внешнего модуля. Результаты. Несросшиеся переломы отмечены у 4 (5,9 %) пострадавших, воспалительные осложнения — у 2 (2,9 %), контрактуры голеностопного сустава — у 4 (5,9 %). Хороший результат отмечен у 55 (80,9 %) пострадавших, удовлетворительный — у 8 (11,1 %), неудовлетворительный — у 5 (7,3 %). Пациенты в период лечения сохраняли мобильность, возможность самообслуживания, осуществляли осевую нагрузку и движения в суставах. Анализ показаний к применению наружного остеосинтеза показал, что при некоторых ситуациях (переломы, сопровождающиеся травматическими или трофическими нарушениями со стороны мягких тканей; переломы большеберцовой кости типа С, двойные (тройные) переломы; перелом костей голени как компонент политравмы; внесуставные переломы костей обеих голеней; лечение несросшихся переломов и дефектов костей) преимущества, которые обеспечивает применение внешней фиксации, превышают неудобства, связанные с наличием наружной конструкции. Выводы. Таким образом, наружный чрескостный остеосинтез является эффективным методом лечения внесуставных переломов костей голени. Опасения, связанные с высокой частотой воспалительных осложнений и неудобствами пребывания в аппарате, при использовании современных конструкций являются преувеличенными. Условием эффективного применения метода является использование конструкций, предусматривающих возможность осевой нагрузки и движений в суставах, этапного воздействия на костные фрагменты, строгое соблюдение технологии вмешательства.

Outcome of Plate Augmentation in Management of Tibial Nonunion After Intramedullary Nailing

<i>Background:</i> Despite the multitude of studies on non union no clear criterion has been established for declaring a fracture as non united. A diagnosis of non union is unjustified, however, until clinical or radiographic evidence shows that healing has ceased and that union is highly improbable. A fracture of the shaft of a long bone should not be considered a non union until at least 6 months after the injury. The incidence of non union in the long bone varies with each bone and with methods of treating acute fractures. More recently, the tibia probably is the most frequent site of non union. Nonunion following intramedullary fixation of tibial fractures is a challenge. Although reamed exchange nailing results are encouraging with union rates, exchange nailing could be extremely challenging due to situations when nail removal is difficult. Augmentation plates gained popularity in management of femoral nonunion with few reports in tibial nonunion. The aim of the current study is to present our results in augmentation plate in management of tibial nonunion with intramedullary nail. <i>Patient and methods:</i> From 2017 till 2021, 20 cases of nonunited tibial fractures fixed by IM nails was included. Augmentation plate without removing the nail in addition of autogenous iliac graft. <i>Results:</i> Union was obtained in all the cases (20 cases) in an average time of about 6.22 months (range 3-12 months). Complications are few included 3 casea of superficial infection and parasthesia at iliac graft site. <i>Conclusion:</i> Plate augmentation without removal of IM nail is a good option in management of aseptic nonunion tibia with excellent results and few complications.

Infected nonunion of the humerus treated by the compression distraction ilizarov technique without radical debridement or bone excision: Case series

Background: External fixators have been proved to be effective in the treatment of infected nonunion fracture humerus. The current study presents the outcome of treatment of infected nonunion of the humerus by a cyclic compression distraction technique using Ilizarov without radical debridement. Materials and Methods: 32 patients, 19 males and 13 females. The mean age of the patients was 39.72 years (range, 27–54); patients were presented by infected nonunited fracture humerus after an average of 1.9 surgeries (range, 1–4). All patients were treated by removal of the hardware if present without radical debridement or bone resection to avoid bone shortening and to preserve the blood supply of the bone and soft tissue, Ilizarov application with cyclic compression distraction. Results: The mean time of the external fixator application was 179.06 days, and the mean follow-up time was 32.8 months. All patients were united, According to the association for the study and application of the method of the ilizarov scoring system, the functional results were excellent in 8 patients, good in 16, fair in 7, and poor in only 1 patient. The bone results were excellent in 9 patients, good in 16, fair in 5, and poor in 2 patients. The mean post-operative DASH score was 32.43 (range, 10–63), the mean visual analog scale (VAS) score for pain was 3.71 (range: 2–5), while the mean VAS score for satisfaction was 7.41 (range: 6–9). Conclusion: Cyclic compression distraction by Ilizarov without radical debridement had shown a satisfactory outcome in the treatment of infected nonunion humerus. Level of Evidence: IV, A retrospective study.

Patterns of Non-union of Femoral Shaft Fracture in Basra Teaching Hospital. A Retrospective review.

Background and objectives: Long bone fractures are witnessed almost every day in the orthopedic practice. Femoral shaft fractures (FSF) generally are due to high energy trauma in working age group. non-union of FSF is not infrequently encountered challenge. This study reviews cases of FSF that ends up with non-union in Basra Teaching Hospital to explore some factors related to non-union. Patients and methods: A retrospective case series were conducted in Basra Teaching Hospital from January 2012 - June 2014 including 124 patient with FSF. Thirty three patients were identified during the study period (18 months), demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate of the patients are described. Results: Among 33 patients with nonunion FSF, 23 were males and 10 females, aged from 15 to 60 years (mean = 35). High energy trauma is the chief source of FSF in this analysis . After 9 - 12 months from initial trauma, patients ends up with non-union, 9 atrophic, 13hypertrophic and 11 infected non-union. Thirty patients underwent revision surgery, with addition of bone graft , three patients no revision surgery, within the study period ( 18 months ), 25achieved successful union or showing signs of progressive union , 3 had united fractures with chronic osteomyelitis , 5 non-united fractures . Conclusion: nonunion of FSF a great challenge to the orthopedic surgeon and the patient life and development, to overcome this problem both the surgeon and the patient should cooperate to avoid this tragedy story.

KIRSCHNER WIRES VERSUS HERBERT SCREW FIXATION WITH BONE GRAFT IN CASE OF NONUNITED SCAPHOID WAIST FRACTURE

Background: Scaphoid nonunion is challenging to manage because of the geometry of the scaphoid, the direction and type of fracture, and the vascular pattern of the blood supply to the scaphoid. Fracture proximal to the perforating vessels on the dorso-radial surface of the scaphoid can cause significant bone ischemia of the proximal pole. Objective: To compare the impact of the Kirschner wires versus Herbert screw fixation with iliac bone graft on the rate of union, time to union, correction of deformity, and clinical outcome in adults with nonunited scaphoid waist fracture without avascular necrosis. Patients and Methods: We prospectively randomized 40 patients to undergo corticocancellous iliac bone grafting and internal fixation either with multiple Kirschner wires or Herbert screw. This study was conducted in the Department of Orthopedic surgery at Al-Hussien University Hospital, Faculty of Medicine, Al-Azhar University during the period from February 2018 to April 2020. Radiographs, clinical outcome measures (pain, range of motion, and grip strength) were done pre- and post-operatively. Results: No significant difference detected between the two groups with respect to the time to union, rate of union, deformity correction, pain analysis, range of motion, grip strength, and complications. Conclusion: Combination of impaction of iliac bone graft, and internal fixation with k-wire or Herbert’s screw provided a good option for treatment of scaphoid nonunion. However, because of kirschner wires has a shorter operative time, lower cost and easy application as compared with the Herbert screw, so k wire may be a good alternative to Herbert screw.

ONE-STAGE VERSUS TWO-STAGE PROTOCOL IN MANAGEMENT OF INFECTED NONUNITED FRACTURE FEMUR; RANDOMIZED CONTROLLED TRIAL

Background: The rate of complex fracture non-unions is increased. Infected non-united fractures need more search for the best method of management.Aim of the work: to compare one-stage protocol (external fixation) and two-stage protocol (debridement, removal of metal, and internal fixation after eradication of infection) in cases of infected non-united fracture femur.Patients and methods: The study was conducted at the Orthopaedic Surgery department Ain Shams University Hospital and Embaba General Hospital from Sep-2017 to Sep-2020 on 20 patients grouped into: one-stage protocol 10 cases and two-stage protocol 10 cases.Results: There was no significant difference between groups concerning age and gender. The healing time was 8.6±2.5 and 8.4±1.7 months for the one-stage group & the two-stage group, respectively. The range of motion of knee six months after healing was significantly (p-value = 0.025) better in the two-stage group. The median (IQR) range of movement was 100 (50) and 110 (30) degrees for the one-stage group & the two-stage group, respectively. The most frequent complication in the one-stage group was PTI (100% of cases); however, in the two-stage group, it was the recurrence of infection (30%), (p-value = 0.01).Conclusion: The two-stage strategy had a better range of motion of knee, less period of immobilization, better psychological status six months after healing but had a higher risk of recurrence of infection.

Operative Treatment of Scaphoid Nonunion

Abstract Background: Scaphoid nonunion result in a predictable pattern of wrist arthrosis. To minimize the incidence of arthrosis, the goal of treatment should be consolidation of the fracture of the scaphoid in anatomic alignment. Aim of Study: To evaluate different means of treatment of scaphoid nonunion and evaluate its clinical results. Patients and Methods: This study was conducted at EL-Helmya Military Hospital and Kasr El-Ainy Hospital during the period from 2011 to 2016 on fifty patients diagnosed as non-united fracture scaphoid and operated upon by fixation and graft if needed, then followed-up for a period of at least 18 months. Patients were 49 male and one female with an average age of 23 years. All operative management and follow-up. Results: This study proved that operative treatment of scaphoid nonunion can be summarized as follows: Grade I,II,III according to Slade and Geissler`s classification can be treated by percutaneous or open fixation by Herbert screw even if the nonunion in prox. Pole. Grade IV/V/VI we have to open volarly for waist or dorsally for prox. Pole and fixation with bone graft from iliac crest or distal radius. Conclusion: This study proves that the goal of treatment of scaphoid nonunion should be consolidation of the fracture in anatomic alignment. scaphoidnonunions with severe collapse and humpback deformity must be approached volarly with interposition of an intercalary bone graft and internal fixation. A dorsal approach to proximal scaphoid nonunions allows immediate access for removing the necrotic bone from small proximal pole nonunions and internal fixation.

Osteosynthesis operation

The osteosynthesis operation for nonunited fractures of long tubular bones requires, according to the majority of modern surgeons, preliminary refreshing and freeing of the ends of the bone fracture from scar tissue.

Radiological union analysis of femoral shaft aseptic nonunion after failed plate and screw convert to reaming intramedullary solid locking nail

Background: Non-united fracture shaft of the femur after plate fixation is a common problem. Management of this problem is still controversial. There are many methods for treating femoral shaft aseptic nonunions with a broken implant which conversion to reaming solid intramedullary nail is one of the procedures. However, the reported success rate varies. This study aimed to evaluate bone healing, especially callus formation, radiologically after nonunion reconstruction using intramedullary nailing reamingMethod: This study is a cross-sectional retrospective case analysis presenting 22 patients with the patient's age was 15 to 50 years old who underwent operation procedures managed by removing the hardware and converting to reaming solid intramedullary locking nail with or without autogenous iliac bone graft for at least six months. The bone healing process was assessed by serial plain radiography every six weeks using the Callus Index method.Results: Conversion to reaming solid intramedullary nailing after nonunion with broken implant gives union rate 95%. Among 22 patients, one patient persisted in nonunion, and two patients experience delayed union. The Callus index of Fracture location (P=0,043) significantly affected index callus formation (P&lt;0.05); The fracture location, whereas fracture classification (P=0,365), nonunion type (P=0,398), and bone graft (P=0,510) did not significantly affect index callus formation (P&gt;0.05). There was no significant difference in time to the solid union between patients with or without iliac autogenous bone graft. Proximal third nonunion affects the time to solid union. No significant complications were noted.Conclusion: Nonunion reconstruction using solid reaming nail at both types nonunion gives a solid union. Solid union achieves with or without bone graft.