The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series
-
Babak Siavashi
,
Mohammad Soleimani
,
Mohammadreza Golbakhsh
,
Mohammad Rastegar
,
Seyyed Hossein Shafiei
Abstract
Background: Several treatment approaches are now considered to manage femoral nonunion following intramedullary (IM) nailing. Augmentation plating over a maintained IM nail was a successful treatment for femur fracture nonunion in recent years. We aimed to describe our experiences in evaluating the union of bone for these patients after plate augmentation with serial examinations and radiologic studies.
Methods: This was a case study on 21 patients who had a nonunion or delayed union of the femoral shaft fracture (FSF) after IM nailing. After initial intervention, they were monitored for 20.4 months (range: 12-72 months).
Results: A closed IM nail was used in 18 patients, while the other three patients were shown as non-IM nail cases with a dynamic hip screw (DHS) in one patient, an external fixator in one other patient, and plate fixation in another one that was planned for augmentation plating. After plating, appropriate union appeared in all patients. Fracture union took an average of 7 months ranging from 3 to 12 months.
Conclusion: Augmentation plating for treating FSF nonunion with leaving the nail in place results in excellent and favorable clinical outcomes with the radiographic recovery of the nonunion site in all of the cases with no complication.
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2. 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].
3. 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].
4. Nork SM. Fractures of the shaft of the femur. In: Bucholz RW, Heckman JD, Court-Brown CM, et al, editors. Rockwood and Green's fractures in adults. 7th ed. Philadelphia, PA: Lippincot Williams & Wilkins, 2010.
5. 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].
6. 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].
7. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop Relat Res. 1986;(212):133-41. [PubMed: 3769279].
8. 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].
9. 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].
10. 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].
11. Ring D, Barrick WT, Jupiter JB. Recalcitrant nonunion. Clin Orthop Relat Res. 1997;(340):181-9. doi: 10.1097/00003086- 199707000-00023. [PubMed: 9224254].
12. Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997;43(4):640-4. doi: 10.1097/00005373-199710000-00013. [PubMed: 9356061].
13. 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. 2021. [In Press].
14. Menon DK, Dougall TW, Pool RD, Simonis RB. Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma. 2002;16(7):491-7. doi: 10.1097/00005131-200208000-00007. [PubMed: 12172279].
15. Chiang JC, Johnson JE, Tarkin IS, Siska PA, Farrell DJ, Mormino MA. Plate augmentation for femoral nonunion: more than just a salvage tool? Arch Orthop Trauma Surg. 2016;136(2):149-56. doi: 10.1007/s00402-015-2365-9. [PubMed: 26646845].
16. Garnavos C. Treatment of aseptic non-union after intramedullary nailing without removal of the nail. Injury. 2017;48(Suppl 1):S76-S81. doi: 10.1016/j.injury.2017.04.022. [PubMed: 28487102].
17. Jhunjhunwala HR, Dhawale AA. Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ? Eur J Trauma Emerg Surg. 2016;42(3):339-43. doi: 10.1007/s00068-015-0534-8. [PubMed: 26038052].
18. Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H. Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics. 2009;32(6):409. doi: 10.3928/01477447-20090511-12. [PubMed: 19634823].
19. Medlock G, Stevenson IM, Johnstone AJ. Uniting the un-united: should established non-unions of femoral shaft fractures initially treated with IM nails be treated by plate augmentation instead of exchange IM nailing? A systematic review. Strategies Trauma Limb Reconstr. 2018;13(3):119-28. doi: 10.1007/s11751-018-0323-0. [PubMed: 30426320]. [PubMed Central: PMC6249146].
20. Said GZ, Said HG, el-Sharkawi MM. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop. 2011;35(7):1089-92. doi: 10.1007/s00264-010-1192-4. [PubMed: 21221576]. [PubMed Central: PMC3167408].
21. Heppenstall RB. Fracture treatment and healing. Philadelphia, PA: Saunders; 1980.
22. El Zahlawy H, Abdeldayem SM, Metwaly RG. Plate augmentation combined with bone grafting for aseptic non- union of femoral shaft fractures following interlocking nails. Acta Orthop Belg. 2019;85(2):205-9. [PubMed: 31315011].
23. Uliana CS, Bidolegui F, Kojima K, Giordano V. Augmentation plating leaving the nail in situ is an excellent option for treating femoral shaft nonunion after IM nailing: A multicentre study. Eur J Trauma Emerg Surg. 2021;47(6): 1895-901. doi: 10.1007/s00068-020-01333-0. [PubMed: 32107562].
24. Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma. 2010;24(2): 89-94. doi: 10.1097/BOT.0b013e3181b8dafd. [PubMed: 20101132].
2. 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].
3. 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].
4. Nork SM. Fractures of the shaft of the femur. In: Bucholz RW, Heckman JD, Court-Brown CM, et al, editors. Rockwood and Green's fractures in adults. 7th ed. Philadelphia, PA: Lippincot Williams & Wilkins, 2010.
5. 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].
6. 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].
7. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop Relat Res. 1986;(212):133-41. [PubMed: 3769279].
8. 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].
9. 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].
10. 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].
11. Ring D, Barrick WT, Jupiter JB. Recalcitrant nonunion. Clin Orthop Relat Res. 1997;(340):181-9. doi: 10.1097/00003086- 199707000-00023. [PubMed: 9224254].
12. Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997;43(4):640-4. doi: 10.1097/00005373-199710000-00013. [PubMed: 9356061].
13. 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. 2021. [In Press].
14. Menon DK, Dougall TW, Pool RD, Simonis RB. Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma. 2002;16(7):491-7. doi: 10.1097/00005131-200208000-00007. [PubMed: 12172279].
15. Chiang JC, Johnson JE, Tarkin IS, Siska PA, Farrell DJ, Mormino MA. Plate augmentation for femoral nonunion: more than just a salvage tool? Arch Orthop Trauma Surg. 2016;136(2):149-56. doi: 10.1007/s00402-015-2365-9. [PubMed: 26646845].
16. Garnavos C. Treatment of aseptic non-union after intramedullary nailing without removal of the nail. Injury. 2017;48(Suppl 1):S76-S81. doi: 10.1016/j.injury.2017.04.022. [PubMed: 28487102].
17. Jhunjhunwala HR, Dhawale AA. Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ? Eur J Trauma Emerg Surg. 2016;42(3):339-43. doi: 10.1007/s00068-015-0534-8. [PubMed: 26038052].
18. Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H. Augmentation plate fixation for the treatment of femoral and tibial nonunion after intramedullary nailing. Orthopedics. 2009;32(6):409. doi: 10.3928/01477447-20090511-12. [PubMed: 19634823].
19. Medlock G, Stevenson IM, Johnstone AJ. Uniting the un-united: should established non-unions of femoral shaft fractures initially treated with IM nails be treated by plate augmentation instead of exchange IM nailing? A systematic review. Strategies Trauma Limb Reconstr. 2018;13(3):119-28. doi: 10.1007/s11751-018-0323-0. [PubMed: 30426320]. [PubMed Central: PMC6249146].
20. Said GZ, Said HG, el-Sharkawi MM. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop. 2011;35(7):1089-92. doi: 10.1007/s00264-010-1192-4. [PubMed: 21221576]. [PubMed Central: PMC3167408].
21. Heppenstall RB. Fracture treatment and healing. Philadelphia, PA: Saunders; 1980.
22. El Zahlawy H, Abdeldayem SM, Metwaly RG. Plate augmentation combined with bone grafting for aseptic non- union of femoral shaft fractures following interlocking nails. Acta Orthop Belg. 2019;85(2):205-9. [PubMed: 31315011].
23. Uliana CS, Bidolegui F, Kojima K, Giordano V. Augmentation plating leaving the nail in situ is an excellent option for treating femoral shaft nonunion after IM nailing: A multicentre study. Eur J Trauma Emerg Surg. 2021;47(6): 1895-901. doi: 10.1007/s00068-020-01333-0. [PubMed: 32107562].
24. Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma. 2010;24(2): 89-94. doi: 10.1097/BOT.0b013e3181b8dafd. [PubMed: 20101132].
| Files | ||
| Issue | Vol 8, No 2 (2022) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v8i2.9312 | |
| Keywords | ||
| Femoral Fractures ; Bone Bone Fractures Bone Transplantation Fracture Malunion | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Siavashi B, Soleimani M, Golbakhsh M, Rastegar M, Shafiei SH. The Effect of Augmentative Plating for the Treatment of Nonunion of Femoral Shaft Fractures after Intramedullary Nailing: A Case Series. J Orthop Spine Trauma. 2022;8(2):57-9.
