Treatment of the Femoral Shaft Nonunion Occurred

Purpose: To evaluate of efficacy of the treatment options for a femoral shaft nonunion occurring after intramedullary nailing. Material and Methods: Thirty-one patients with nonunion of a femoral shaft fracture, who had been treated with interlocking intramedullary nailing from January 1996 to December 2000, were examined. Twenty-six had oligotrophic nonunion and five were hypervascular. Forty-five procedures were performed for 31 nonunions; bone grafting for 14, exchange nailing for 13, plate augmentation and bone grafting for 14 and dynamization for 4 cases. Results: The success rate after a single procedure was only 58%. The four dynamization cases failed to unite. Seven of the 13 (54%) nonunion cases treated with nail exchange healed satis-factorily. All cases treated with plate augmentation and bone grafting achieved successful union. The mean period from fracture to union was 20 months. Conclusion: Exchange nailing is not always a reliable procedure for treating nonunion of a femoral shaft fracture. Plate augmentation and bone grafting were found to be a successful mode of therapy for the femoral shaft nonunion without complications