Thurs., 10/18/07 Femur, Paper #6, 1:37 pm OTA-2007
Treatment of Nonunion after Femoral Nailing
Kyu Hyun Yang, MD (e-Zimmer); Han Kook Yoon, MD (n);
Jin Park, MD (n); Sul Gee Kim, MD (n);
Yonsei University College of Medicine, Seoul, Korea
Purpose: Intramedullary nailing is the standard treatment of most acute femoral shaft fractures in adults. Expansion of indication and wide use of intramedullary nailing has induced increased incidence of nonunion after shaft nailing. We performed retrospective study to assess the effectiveness of different surgical options for femoral shaft nonunion after femoral shaft nailing.
Methods: We retrospectively studied 63 patients with nonunion of the femoral shaft fracture that had been treated with intramedullary nailing from November 1996 to June 2006. There were 44 male patients and 19 female patients with a mean age of 40 years. 31 were hypervascular type and 32 were atrophic type nonunions. Surgical options were exchange femoral nailing (34 cases), augmentative plate fixation with bone graft (20 cases), conversion to plate fixation (7 cases), and bone graft only (2 cases). Indications of augmentative plate fixation were failure in attempted removal of nail, comminution with defect around the nail, and wide medullary canal. Conversion to plate fixation was performed in malaligned cases. Bone graft only was performed in selected cases that had firm internal fixation but large defect.
Results: Of 34 nonunion cases treated with exchange femoral nailing, 28 cases (82%) were healed satisfactorily by one operation. The mean union period was 6 months. In the six cases that could not achieve union by exchange femoral nailing, severe primary comminution of the fracture was present in four cases. In the other two cases, the nonunited site was in the distal and proximal third. Five cases were treated with augmentative plate fixation and bone graft, one with bone graft alone. Failure in exchange femoral nailing was significantly higher in comminuted (P = 0.031) and nondiaphyseal cases (P = 0.048 ) by Fisher exact test. All of the cases treated with augmentative plate fixation and conversion to plate fixation had successful union.
Conclusion and Significance: Exchange nailing, if possible, seems to be effective to treat nonunion after intramedullary nailing, especially in diaphyseal and noncomminuted fracture. In some selected cases, such as comminuted and metaphyseal area, augmentative plate fixation with bone graft is considered to be an excellent choice.If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• 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.