The Treatment of Nonisthmal Femoral Shaft Nonunions With IM Nail Exchange Versus Augmentation Plating

Objectives: The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) will) a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. Design: Retrospective data analysis, November 1996-March 2006 Setting: A level I trauma center. Patients: Eighteen patients with IS nonisthmal femoral nonunions Intervention: Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and I I patients with I I fractures treated for nonisthmal femoral shaft nonunions after nailing with A-P combined with bone grafting. Main Outcome Measure: Union and complications. Results: Five nonunions EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shall nonunion (odds ratio, 6.5; P = 0.002). Conclusions: AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.