Evaluating the Effect of Double Plating Fixation with Bone Graft in Nonunion of Femoral and Tibial Fractures after Primary Surgery
-
Babak Siavashi
,
Mohammad Rastegar
,
Yousof Fallah
,
Ehsan Pendar
,
Mohammad Soleimani
,
Seyyed Hossein Shafiei
Abstract
Background: Several treatment approaches are now considered to manage tibial and femoral shaft nonunion after primary surgeries. Double-locking plates with channel bone grafting technology are treatments that surgeons could choose. We aimed to describe our experiences in evaluating the union of bone for these patients after using double-locking plates with channel bone grafting with serial examinations and radiologic studies.
Methods: This case study was conducted on 33 patients consisting of 20 femoral nonunion and 13 tibial nonunion cases. They underwent double plate fixation with bone grafting at Sina Hospital, Tehran, Iran, from 2015 to 2020. They were monitored for an average of 60 months after surgery.
Results: Union was achieved in all the patients in a mean of 10.03 months (range: 8-18 months). During patients’ follow-up, no plate and screw breakage, device loosening, deformity, and infection were seen. No additional surgery was needed for any of our patients. Conclusion: There are various treatment options for nonunion of long bones. This study described the double plating approach for treating femoral and tibial shaft nonunion. The technique of double plate fixation and bone grafting had reasonable union rates in long bone nonunion. The present case series analysis also shows that it is more beneficial to manipulate this promising method for long bone nonunion whenever possible.
1. Larsen P, Elsoe R, Hansen SH, Graven-Nielsen T, Laessoe U, Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746-50. doi: 10.1016/j.injury.2014.12.027. [PubMed: 25636535].
2. Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury. 2009;40(3): 304-8. doi: 10.1016/j.injury.2008.07.017. [PubMed: 19171340].
3. Gansslen A, Gosling T, Hildebrand F, Pape HC, Oestern HJ. Femoral shaft fractures in adults: Treatment options and controversies. Acta Chir Orthop Traumatol Cech. 2014;81(2): 108-17. [PubMed: 25105784].
4. Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: A systematic review and meta-analysis. Int Orthop. 2018;42(11):2675-83. doi: 10.1007/s00264-018-3864-4. [PubMed: 29516238].
5. Brinker MR, Hanus BD, Sen M, O'Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am. 2013;95(24):2170-6. doi: 10.2106/JBJS.L.00803. [PubMed: 24352770].
6. Schottel PC, O'Connor DP, Brinker MR. Time trade-off as a measure of health-related quality of life: Long bone nonunions have a devastating impact. J Bone Joint Surg Am. 2015;97(17):1406-10. doi: 10.2106/JBJS.N.01090. [PubMed: 26333735]. [PubMed Central: PMC7535097].
7. Bucholz RW, Jones A. Fractures of the shaft of the femur. J Bone Joint Surg Am. 1991;73(10):1561-6. [PubMed: 1748704].
8. Finkemeier CG, Chapman MW. Treatment of femoral diaphyseal nonunions. Clin Orthop Relat Res. 2002;(398):223-34. doi: 10.1097/00003086-200205000-00031. [PubMed: 11964654].
9. Wiss DA, Brien WW, Stetson WB. Interlocked nailing for treatment of segmental fractures of the femur. J Bone Joint Surg Am. 1990;72(5):724-8. [PubMed: 2355034].
10. Bellabarba C, Ricci WM, Bolhofner BR. Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing. J Orthop Trauma. 2001;15(4):254-63. doi: 10.1097/00005131-200105000-00004. [PubMed: 11371790].
11. Bungaro P, Pascarella R, Colozza A, Zinghi GF. Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur. Chir Organi Mov. 1999;84(3):263-7. [PubMed: 11569041].
12. Ring D, Barrick WT, Jupiter JB. Recalcitrant nonunion. Clin Orthop Relat Res. 1997;(340):181-9. doi: 10.1097/00003086- 199707000-00023. [PubMed: 9224254].
13. Kurylo JC, Tornetta P 3rd. Extra-articular proximal tibial
fractures: Nail or plate? Instr Course Lect. 2013;62:61-77. [PubMed: 23395015].
14. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma. 2009;23(7):485-92. doi: 10.1097/BOT.0b013e3181b013d2. [PubMed: 19633457].
15. Erturer E, Ozturk I, Dirik Y, Uzun M, Aksoy B. Radiographic and functional results of osteosynthesis with locked unreamed intramedullary nailing of femoral shaft fractures in adults. Acta Orthop Traumatol Turc. 2005;39(5):381-6. [PubMed: 16531693].
16. Maimaitiyiming A, Amat A, Rehei A, Tusongjiang M, Li C. Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury. 2015;46(6):1102-7. doi: 10.1016/j.injury.2015.01.009. [PubMed: 25712702].
17. Sun L, Li Z, Ma T, Xue HZ, Wang Q, Lu DG, et al. Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients. J Int Med Res. 2019;47(5):1998-2010. doi: 10.1177/0300060518814607. [PubMed: 30880524]. [PubMed Central: PMC6567751].
18. Lynch JR, Taitsman LA, Barei DP, Nork SE. Femoral nonunion: risk factors and treatment options. J Am Acad Orthop Surg. 2008;16(2):88-97. doi: 10.5435/00124635-200802000-00006. [PubMed: 18252839].
19. Saeedreza M, Reza SK, Alireza A. Evaluating the risk factors of nonunion in long bone fractures of patients referred to Dr Shariati Hospital’s Orthopedic Clinic during 2007-2013. J Orthop Spine Trauma. 2015;1(1): e3554.
20. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma. 2002;16(6):394-402. doi: 10.1097/00005131-200207000-00005. [PubMed: 12142827].
21. Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma. 1997;43(2):263-7. doi: 10.1097/00005373-199708000-00010. [PubMed: 9291371].
22. Matsuda Y, Sakayama K, Okumura H, Kawatani Y, Mashima N, Shibata T. Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nihon Geka Hokan. 1998;67(1):10-7. [PubMed: 10401231].
23. Marti RK, Kloen P. Concepts and cases in nonunion treatment. New York, NY: Thieme; 2011.
24. Canadian Orthopaedic Trauma Society. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am. 2003;85(11):2093-6. [PubMed: 14630836].
25. Harshwal RK, Sankhala SS, Jalan D. Management of nonunion of lower-extremity long bones using mono-lateral external fixator-report of 37 cases. Injury. 2014;45(3):560-7. doi: 10.1016/j.injury.2013.11.019. [PubMed: 24342368].
26. Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br. 2006;88(7):928-32. doi: 10.1302/0301-620X.88B7.17639. [PubMed: 16798998].
27. Lammens J, Van LM, Motmans R. Ilizarov treatment for femoral mal-union or non-union associated with fatigue
fracture of an intramedullary nail. Injury. 2008;39(2):256-9. doi: 10.1016/j.injury.2007.07.026. [PubMed: 18164004].
28. Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation for long-bone fracture-healing: A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2008;90(11):2322-30. doi: 10.2106/JBJS.H.00111. [PubMed: 18978400].
29. Kooistra BW, Jain A, Hanson BP. Electrical stimulation: Nonunions. Indian J Orthop. 2009;43(2):149-55. doi: 10.4103/0019- 5413.50849. [PubMed: 19838363]. [PubMed Central: PMC2762246].
30. Kim SJ, Shin SJ, Yang KH, Moon SH, Lee SC. Endoscopic bone graft for delayed union and nonunion. Yonsei Med J. 2000;41(1):107-11. doi: 10.3349/ymj.2000.41.1.107. [PubMed: 10731927].
31. Wang JW, Weng LH. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg Am. 2003;85(3):436-40. doi: 10.2106/00004623-200303000-00006. [PubMed: 12637428].
32. Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orthop Relat Res. 1986;(212):18-25. [PubMed: 3769284].
33. Oh JK, Bae JH, Oh CW, Biswal S, Hur CR. Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft. Injury. 2008;39(8):952-9. doi: 10.1016/j.injury.2008.02.024. [PubMed: 18579143].
34. Danckwardt-Lilliestrom G. Reaming of the medullary cavity and its effect on diaphyseal bone. A fluorochromic, microangiographic and histologic study on the rabbit tibia and dog femur. Acta Orthop Scand Suppl. 1969;128:1-153. doi: 10.3109/ort.1969.40.suppl-128.01. [PubMed: 4192328].
35. Klein MP, Rahn BA, Frigg R, Kessler S, Perren SM. Reaming versus non-reaming in medullary nailing: Interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg. 1990;109(6):314-6. doi: 10.1007/BF00636168. [PubMed: 2073449].
36. Grundnes O, Reikeras O. Acute effects of intramedullary reaming on bone blood flow in rats. Acta Orthop Scand. 1993;64(2):203-6. doi: 10.3109/17453679308994571. [PubMed: 8498187].
37. Reichert IL, McCarthy ID, Hughes SP. The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia. J Bone Joint Surg Br. 1995;77(3):490-3. [PubMed: 7744943].
38. Whiteside LA, Ogata K, Lesker P, Reynolds FC. The acute effects of periosteal stripping and medullary reaming on regional bone blood flow. Clin Orthop Relat Res. 1978;(131):266-72. [PubMed: 657634].
39. Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000;14(3):178-82. doi: 10.1097/00005131-200003000-00005. [PubMed: 10791668].
40. Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA. The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma. 2009;23(9):653-7. doi: 10.1097/BOT.0b013e3181a2a337. [PubMed: 19897987].
41. Hierholzer C, Glowalla C, Herrler M, von Ruden C, Hungerer S, Buhren V, et al. Reamed intramedullary exchange nailing: Treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res. 2014;9:88. doi: 10.1186/s13018-014-0088-1. [PubMed: 25300373]. [PubMed Central: PMC4201668].
42. Swanson EA, Garrard EC, Bernstein DT, O'Connor DP, Brinker MR. Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma. 2015;29(1):21-7. doi: 10.1097/BOT.0000000000000166. [PubMed: 24978947].
43. Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000;14(5):335-8. doi: 110.1097/00005131-200006000-00005. [PubMed: 10926240].
44. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury. 2003;34(5):349-56. doi: 10.1016/s0020- 1383(02)00191-2. [PubMed: 12719163].
45. Steinberg EL, Keynan O, Sternheim A, Drexler M, Luger E. Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system. Injury. 2009;40(3):309-14. doi: 10.1016/j.injury.2008.07.029. [PubMed: 19249781].
46. Wu CC, Lee ZL. Treatment of femoral shaft aseptic nonunion associated with broken distal locked screws and shortening. J Trauma. 2005;58(4):837-40. doi: 10.1097/01.ta.0000136307.63608.6d. [PubMed: 15824665].
47. Chapman MW, Finkemeier CG. Treatment of supracondylar nonunions of the femur with plate fixation and bone graft. J Bone Joint Surg Am. 1999;81(9):1217-28. doi: 10.2106/00004623- 199909000-00003. [PubMed: 10505518].
48. Wu CC, Shih CH. Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg. 1993;36(4):302-6. [PubMed: 8370009].
49. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241:146–65. [PubMed: 2924458].
2. Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: Stable incidence between 1998 and 2004. Injury. 2009;40(3): 304-8. doi: 10.1016/j.injury.2008.07.017. [PubMed: 19171340].
3. Gansslen A, Gosling T, Hildebrand F, Pape HC, Oestern HJ. Femoral shaft fractures in adults: Treatment options and controversies. Acta Chir Orthop Traumatol Cech. 2014;81(2): 108-17. [PubMed: 25105784].
4. Koso RE, Terhoeve C, Steen RG, Zura R. Healing, nonunion, and re-operation after internal fixation of diaphyseal and distal femoral fractures: A systematic review and meta-analysis. Int Orthop. 2018;42(11):2675-83. doi: 10.1007/s00264-018-3864-4. [PubMed: 29516238].
5. Brinker MR, Hanus BD, Sen M, O'Connor DP. The devastating effects of tibial nonunion on health-related quality of life. J Bone Joint Surg Am. 2013;95(24):2170-6. doi: 10.2106/JBJS.L.00803. [PubMed: 24352770].
6. Schottel PC, O'Connor DP, Brinker MR. Time trade-off as a measure of health-related quality of life: Long bone nonunions have a devastating impact. J Bone Joint Surg Am. 2015;97(17):1406-10. doi: 10.2106/JBJS.N.01090. [PubMed: 26333735]. [PubMed Central: PMC7535097].
7. Bucholz RW, Jones A. Fractures of the shaft of the femur. J Bone Joint Surg Am. 1991;73(10):1561-6. [PubMed: 1748704].
8. Finkemeier CG, Chapman MW. Treatment of femoral diaphyseal nonunions. Clin Orthop Relat Res. 2002;(398):223-34. doi: 10.1097/00003086-200205000-00031. [PubMed: 11964654].
9. Wiss DA, Brien WW, Stetson WB. Interlocked nailing for treatment of segmental fractures of the femur. J Bone Joint Surg Am. 1990;72(5):724-8. [PubMed: 2355034].
10. Bellabarba C, Ricci WM, Bolhofner BR. Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing. J Orthop Trauma. 2001;15(4):254-63. doi: 10.1097/00005131-200105000-00004. [PubMed: 11371790].
11. Bungaro P, Pascarella R, Colozza A, Zinghi GF. Rigid fixation with plate and bone graft in failures of intramedullary osteosynthesis for the treatment of diaphyseal nonunion of the femur. Chir Organi Mov. 1999;84(3):263-7. [PubMed: 11569041].
12. Ring D, Barrick WT, Jupiter JB. Recalcitrant nonunion. Clin Orthop Relat Res. 1997;(340):181-9. doi: 10.1097/00003086- 199707000-00023. [PubMed: 9224254].
13. Kurylo JC, Tornetta P 3rd. Extra-articular proximal tibial
fractures: Nail or plate? Instr Course Lect. 2013;62:61-77. [PubMed: 23395015].
14. Lindvall E, Sanders R, Dipasquale T, Herscovici D, Haidukewych G, Sagi C. Intramedullary nailing versus percutaneous locked plating of extra-articular proximal tibial fractures: comparison of 56 cases. J Orthop Trauma. 2009;23(7):485-92. doi: 10.1097/BOT.0b013e3181b013d2. [PubMed: 19633457].
15. Erturer E, Ozturk I, Dirik Y, Uzun M, Aksoy B. Radiographic and functional results of osteosynthesis with locked unreamed intramedullary nailing of femoral shaft fractures in adults. Acta Orthop Traumatol Turc. 2005;39(5):381-6. [PubMed: 16531693].
16. Maimaitiyiming A, Amat A, Rehei A, Tusongjiang M, Li C. Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury. 2015;46(6):1102-7. doi: 10.1016/j.injury.2015.01.009. [PubMed: 25712702].
17. Sun L, Li Z, Ma T, Xue HZ, Wang Q, Lu DG, et al. Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients. J Int Med Res. 2019;47(5):1998-2010. doi: 10.1177/0300060518814607. [PubMed: 30880524]. [PubMed Central: PMC6567751].
18. Lynch JR, Taitsman LA, Barei DP, Nork SE. Femoral nonunion: risk factors and treatment options. J Am Acad Orthop Surg. 2008;16(2):88-97. doi: 10.5435/00124635-200802000-00006. [PubMed: 18252839].
19. Saeedreza M, Reza SK, Alireza A. Evaluating the risk factors of nonunion in long bone fractures of patients referred to Dr Shariati Hospital’s Orthopedic Clinic during 2007-2013. J Orthop Spine Trauma. 2015;1(1): e3554.
20. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma. 2002;16(6):394-402. doi: 10.1097/00005131-200207000-00005. [PubMed: 12142827].
21. Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma. 1997;43(2):263-7. doi: 10.1097/00005373-199708000-00010. [PubMed: 9291371].
22. Matsuda Y, Sakayama K, Okumura H, Kawatani Y, Mashima N, Shibata T. Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nihon Geka Hokan. 1998;67(1):10-7. [PubMed: 10401231].
23. Marti RK, Kloen P. Concepts and cases in nonunion treatment. New York, NY: Thieme; 2011.
24. Canadian Orthopaedic Trauma Society. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am. 2003;85(11):2093-6. [PubMed: 14630836].
25. Harshwal RK, Sankhala SS, Jalan D. Management of nonunion of lower-extremity long bones using mono-lateral external fixator-report of 37 cases. Injury. 2014;45(3):560-7. doi: 10.1016/j.injury.2013.11.019. [PubMed: 24342368].
26. Patil S, Montgomery R. Management of complex tibial and femoral nonunion using the Ilizarov technique, and its cost implications. J Bone Joint Surg Br. 2006;88(7):928-32. doi: 10.1302/0301-620X.88B7.17639. [PubMed: 16798998].
27. Lammens J, Van LM, Motmans R. Ilizarov treatment for femoral mal-union or non-union associated with fatigue
fracture of an intramedullary nail. Injury. 2008;39(2):256-9. doi: 10.1016/j.injury.2007.07.026. [PubMed: 18164004].
28. Mollon B, da Silva V, Busse JW, Einhorn TA, Bhandari M. Electrical stimulation for long-bone fracture-healing: A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2008;90(11):2322-30. doi: 10.2106/JBJS.H.00111. [PubMed: 18978400].
29. Kooistra BW, Jain A, Hanson BP. Electrical stimulation: Nonunions. Indian J Orthop. 2009;43(2):149-55. doi: 10.4103/0019- 5413.50849. [PubMed: 19838363]. [PubMed Central: PMC2762246].
30. Kim SJ, Shin SJ, Yang KH, Moon SH, Lee SC. Endoscopic bone graft for delayed union and nonunion. Yonsei Med J. 2000;41(1):107-11. doi: 10.3349/ymj.2000.41.1.107. [PubMed: 10731927].
31. Wang JW, Weng LH. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg Am. 2003;85(3):436-40. doi: 10.2106/00004623-200303000-00006. [PubMed: 12637428].
32. Kessler SB, Hallfeldt KK, Perren SM, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing. Clin Orthop Relat Res. 1986;(212):18-25. [PubMed: 3769284].
33. Oh JK, Bae JH, Oh CW, Biswal S, Hur CR. Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft. Injury. 2008;39(8):952-9. doi: 10.1016/j.injury.2008.02.024. [PubMed: 18579143].
34. Danckwardt-Lilliestrom G. Reaming of the medullary cavity and its effect on diaphyseal bone. A fluorochromic, microangiographic and histologic study on the rabbit tibia and dog femur. Acta Orthop Scand Suppl. 1969;128:1-153. doi: 10.3109/ort.1969.40.suppl-128.01. [PubMed: 4192328].
35. Klein MP, Rahn BA, Frigg R, Kessler S, Perren SM. Reaming versus non-reaming in medullary nailing: Interference with cortical circulation of the canine tibia. Arch Orthop Trauma Surg. 1990;109(6):314-6. doi: 10.1007/BF00636168. [PubMed: 2073449].
36. Grundnes O, Reikeras O. Acute effects of intramedullary reaming on bone blood flow in rats. Acta Orthop Scand. 1993;64(2):203-6. doi: 10.3109/17453679308994571. [PubMed: 8498187].
37. Reichert IL, McCarthy ID, Hughes SP. The acute vascular response to intramedullary reaming. Microsphere estimation of blood flow in the intact ovine tibia. J Bone Joint Surg Br. 1995;77(3):490-3. [PubMed: 7744943].
38. Whiteside LA, Ogata K, Lesker P, Reynolds FC. The acute effects of periosteal stripping and medullary reaming on regional bone blood flow. Clin Orthop Relat Res. 1978;(131):266-72. [PubMed: 657634].
39. Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000;14(3):178-82. doi: 10.1097/00005131-200003000-00005. [PubMed: 10791668].
40. Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA. The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma. 2009;23(9):653-7. doi: 10.1097/BOT.0b013e3181a2a337. [PubMed: 19897987].
41. Hierholzer C, Glowalla C, Herrler M, von Ruden C, Hungerer S, Buhren V, et al. Reamed intramedullary exchange nailing: Treatment of choice of aseptic femoral shaft nonunion. J Orthop Surg Res. 2014;9:88. doi: 10.1186/s13018-014-0088-1. [PubMed: 25300373]. [PubMed Central: PMC4201668].
42. Swanson EA, Garrard EC, Bernstein DT, O'Connor DP, Brinker MR. Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions. J Orthop Trauma. 2015;29(1):21-7. doi: 10.1097/BOT.0000000000000166. [PubMed: 24978947].
43. Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000;14(5):335-8. doi: 110.1097/00005131-200006000-00005. [PubMed: 10926240].
44. Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury. 2003;34(5):349-56. doi: 10.1016/s0020- 1383(02)00191-2. [PubMed: 12719163].
45. Steinberg EL, Keynan O, Sternheim A, Drexler M, Luger E. Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system. Injury. 2009;40(3):309-14. doi: 10.1016/j.injury.2008.07.029. [PubMed: 19249781].
46. Wu CC, Lee ZL. Treatment of femoral shaft aseptic nonunion associated with broken distal locked screws and shortening. J Trauma. 2005;58(4):837-40. doi: 10.1097/01.ta.0000136307.63608.6d. [PubMed: 15824665].
47. Chapman MW, Finkemeier CG. Treatment of supracondylar nonunions of the femur with plate fixation and bone graft. J Bone Joint Surg Am. 1999;81(9):1217-28. doi: 10.2106/00004623- 199909000-00003. [PubMed: 10505518].
48. Wu CC, Shih CH. Effect of dynamization of a static interlocking nail on fracture healing. Can J Surg. 1993;36(4):302-6. [PubMed: 8370009].
49. Paley D, Catagni MA, Argnani F, Villa A, Benedetti GB, Cattaneo R. Ilizarov treatment of tibial nonunions with bone loss. Clin Orthop Relat Res. 1989;241:146–65. [PubMed: 2924458].
| Files | ||
| Issue | Vol 8, No 2 (2022) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v8i2.9310 | |
| Keywords | ||
| Femoral Fractures Tibial Fractures Ununited Fractures | ||
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How to Cite
1.
Siavashi B, Rastegar M, Fallah Y, Pendar E, Soleimani M, Shafiei SH. Evaluating the Effect of Double Plating Fixation with Bone Graft in Nonunion of Femoral and Tibial Fractures after Primary Surgery. J Orthop Spine Trauma. 2022;8(2):48-51.
