OTA 2012 Posters

Scientific Poster #10 Hip/Femur OTA-2012

Aseptic Diaphyseal Femoral Nonunions: Exchange Intramedullary Nailing Versus Dynamization

Jeffrey P. Garrett, MD; Rafael Serrano-Riera, MD; H. Claude Sagi, MD;
Orthopaedic Trauma Service, Florida Orthopaedic Institute, Tampa, Florida, USA

Purpose: Intramedullary nailing is the gold standard treatment for fractures of the femoral diaphysis. For those fractures in which nonunion occurs, different treatment strategies are available. The purpose of this study is to compare the union rates of aseptic femoral diaphyseal nonunions using intramedullary nail dynamization and those using exchange intramedullary nailing with and without bone graft.

Methods: Between 2002 and 2010, 1099 femoral shaft fractures were treated with an intramedullary nail. 46 patients with aseptic femoral diaphyseal nonunions without segmental defect and either a spiral (32 A1.2), oblique (32 A2.2), or transverse (32 A3.2) fracture line were identified in 42 patients and included in the study. All patients were initially treated with intramedullary nailing and subsequently had radiographic and clinical findings of symptomatic nonunion. Time to treatment until diagnosis of nonunion averaged 11 months (range, 3-30 months). Patients were excluded if they were skeletally immature or had a history of bone infection, tumor, or metabolic disorder. The study population was divided into three groups for analysis: group one, nail dynamization (ND) only; group two, exchange intramedullary nailing (XIM) only; and group three, exchange intramedullary nailing with open bone grafting (XIMG) of the nonunion site. Clinical data were analyzed using Fisher exact test.

Results: There were 11 patients in group one, 20 patients in group two, and 22 patients in group three. Age, gender, and fracture patterns did not differ significantly between the three groups. Success rates were as follows: group one (ND), 2 of 11 (18%) nonunions healed; group two (XIM), 14 of 20 (70%) nonunions healed; group three (XIMG), 20 of 22 (93%) nonunions healed. The differences between group one and groups two and three were statistically significant (P = 0.003).

Conclusions: We found exchange intramedullary nailing to be significantly more effective than dynamization in the treatment of aseptic femoral diaphyseal nonunions. Union was also improved with the addition of bone autograft at the time of exchange although this was not statistically significant.

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.