Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study

• Published in: BMC musculoskeletal disorders Vol. 20; no. 1; pp. 127 - 7
• Main Authors: Lai, Po-Ju, Hsu, Yung-Heng, Chou, Ying-Chao, Yeh, Wen-Ling, Ueng, Steve W. N., Yu, Yi-Hsun
• Format: Journal Article
• Language: English
• Published: London BioMed Central 25.03.2019; BioMed Central Ltd; Springer Nature B.V; BMC
• Subjects: Adult; Asepsis - instrumentation; Asepsis - methods; Augmentative plate; Bone Nails; Bone Plates; Care and treatment; Cohort analysis; Cohort Studies; Dimensional analysis; Epidemiology; Exchanging reamed nail; Female; Femoral Fractures - diagnostic imaging; Femoral Fractures - surgery; Femur; Fracture Fixation, Intramedullary - methods; Fractures; Fractures (Injuries); Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Humans; Internal Medicine; Male; Medical records; Medicine; Medicine & Public Health; Middle Aged; Musculoskeletal diseases; Nonunion; Nonunion femoral shaft fracture; Orthopedic fixation devices; Orthopedics; Orthopedics and biomechanics; Osteosynthesis; Patients; Rehabilitation; Research Article; Retrospective Studies; Rheumatology; Rotation; Skin & tissue grafts; Sports Medicine; Surgery; Surgical outcomes; Trauma; Treatment Outcome; Young Adult; Augmentative plate; Nonunion femoral shaft fracture; Exchanging reamed nail
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-019-2514-3

Background Atrophic nonunion of femoral shaft fracture after intramedullary (IM) nailing is uncommon. The treatment for femoral shaft aseptic atrophic non-union remained controversial. The aim of this study was to compare the surgical results between exchanging reamed nailing (ERN) and augmentative antirotational plating (AAP) for femoral shaft aseptic atrophic nonunion. Methods We retrospectively reviewed the patients with femoral shaft nonunion between the year of 2014 and 2015. The patients with nonunion after plate osteosynthesis, septic nonunion, hypertrophic nonunion, additional surgery during revision surgery were excluded. All the patients were followed up at least 12 months. Results Overall, the union rate after revision surgery was 70.8%. The union rate was significantly higher in the AAP group than in the ERN group. Operating time was also significantly shorter in the AAP group. Regarding the location of nonunion, the union rate was comparable between groups for isthmic nonunions. However, for non-isthmic nonunions, the union rate was significantly higher and operating time was significantly shorter in the AAP group. Conclusion AAP showed an overall higher union rate for management of femoral shaft aseptic atrophic nonunion compared with ERN. Especially for non-isthmic femoral shaft atrophic nonunions, AAP provided a significantly higher union rate and significantly shorter operating time.