- Discussion:
- general discussion of non union / infected femoral nails
- femoral shaft that has not healed in 26 wks signals a delayed union;
- may be more common in segmental fractures and in winquest type IV fractures;
- most common iatrogenic risk factor is failure to ream the canal; (see femoral reaming)
- references:
- Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.
- Human atrophic fracture non-unions are not avascular.
- Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial.
- Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial.
- Retrograde dynamic locked nailing for femoral supracondylar nonunions after plating.
- Treatment Options:
- see bone graft menu
- Exchange Nailing:
- consider removing nail, reaming of canal, & inserting larger nail;
- difficulty passing guide wire across a dense sclerotic nonunion may require special instrumentation or opening of the frx site;
- consider reaming to 2 mm above the previous size, & delivering bone graft to site of non union thru a chest tube, and inserting
larger IM nail;
- in the report by Giannoudis, et al, the authors emphasize the importance of avoiding NSAIDS, using bone grafting, as well as
reaming above the previous nail size;
- in the report by Weresh MJ et al, the authors noted that a significant number of patients undergoing reamed exchange nailing
of femoral shaft non unions required additional procedures to achieve fracture healing;
- they noted that exchange nailing by itself may not be sufficient for fracture healing;
- retrograde IM nailing: may be useful for distal femur frx, treated with prior antegrade nailing;
- references:
- Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.
- The treatment of nonunions following intramedullary nailing of femoral shaft fractures.
- Simple approach to the management of aseptic non-union of the shaft of long bones.
- Exchange nailing for femoral shaft aseptic non-union.
- [Treatment results of aseptic non-unions of long bones with medullary canal reaming followed by intramedullary nailing]
- Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union.
- Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures.
- The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing.
- Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail.
- Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases.
- Distal femoral nonunion treated with interlocking nailing.
- Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft
- Femoral exchange nailing for aseptic non-union: not the end to all problems.
- The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions.
- Retrograde dynamic locked nailing for aseptic nonunion of femoral supracondyle after antegrade locked nailing
- Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure
- Effectiveness of plate augmentation for femoral shaft nonunion after nailing.
- The Results of a Systematic Approach to Exchange Nailing for the Treatment of Aseptic Femoral Nonunions.
- nail dynamization:
- plate augmentation (over nail):
- references:
- Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
- Effectiveness of plate augmentation for femoral shaft nonunion after nailing
- The treatment of nonisthmal femoral shaft nonunions with intramedullary nail exchange versus augmentation plating
- Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting
- Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience.
- Indications and outcomes of augmentation plating with decortication and bone grafting for femoral shaft nonunions.
- Plate augmentation for femoral nonunion: more than just a salvage tool?
- plate fixation: (see synthes distal femoral plate and discussion of plates)
- allows direct debridement of non union ends, anatomic reduction, bone grafting and compression;
- in the report by Bellabarba C, et al, the authors report on a consectutive series of 23 femoral non unions of femoral shaft
fractures treated by previous IM nailing;
- surgical treatment consisted of indirect fracture reduction techniques using 95 deg condylar blade plate;
- 21 of 23 non unions healed without further intervention (two other fractures had hardware failure);
- references:
- Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing
- Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.
- Mechanical comparison of a distal femoral side plate and a retrograde intramedullary nail.
- The use of a locked plate in the treatment of ununited femoral shaft fractures.
- The evolution of femoral shaft plating technique.
- Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing.
- Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.
- Open reduction and internal fixation of distal femoral nonunions: long-term functional outcomes following a treatment protocol.
- Management of infected femoral nonunions with a single-staged protocol utilizing internal fixation.
- Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients.
- Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions.
- general discussion of non union / infected femoral nails
- femoral shaft that has not healed in 26 wks signals a delayed union;
- may be more common in segmental fractures and in winquest type IV fractures;
- most common iatrogenic risk factor is failure to ream the canal; (see femoral reaming)
- references:
- Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.
- Human atrophic fracture non-unions are not avascular.
- Antegrade or retrograde reamed femoral nailing. A prospective, randomised trial.
- Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial.
- Retrograde dynamic locked nailing for femoral supracondylar nonunions after plating.
- Treatment Options:
- see bone graft menu
- Exchange Nailing:
- consider removing nail, reaming of canal, & inserting larger nail;
- difficulty passing guide wire across a dense sclerotic nonunion may require special instrumentation or opening of the frx site;
- consider reaming to 2 mm above the previous size, & delivering bone graft to site of non union thru a chest tube, and inserting
larger IM nail;
- in the report by Giannoudis, et al, the authors emphasize the importance of avoiding NSAIDS, using bone grafting, as well as
reaming above the previous nail size;
- in the report by Weresh MJ et al, the authors noted that a significant number of patients undergoing reamed exchange nailing
of femoral shaft non unions required additional procedures to achieve fracture healing;
- they noted that exchange nailing by itself may not be sufficient for fracture healing;
- retrograde IM nailing: may be useful for distal femur frx, treated with prior antegrade nailing;
- references:
- Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs.
- The treatment of nonunions following intramedullary nailing of femoral shaft fractures.
- Simple approach to the management of aseptic non-union of the shaft of long bones.
- Exchange nailing for femoral shaft aseptic non-union.
- [Treatment results of aseptic non-unions of long bones with medullary canal reaming followed by intramedullary nailing]
- Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union.
- Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures.
- The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing.
- Treatment of infected pseudarthrosis of the femur and tibia with an interlocking nail.
- Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases.
- Distal femoral nonunion treated with interlocking nailing.
- Treatment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft
- Femoral exchange nailing for aseptic non-union: not the end to all problems.
- The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions.
- Retrograde dynamic locked nailing for aseptic nonunion of femoral supracondyle after antegrade locked nailing
- Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure
- Effectiveness of plate augmentation for femoral shaft nonunion after nailing.
- The Results of a Systematic Approach to Exchange Nailing for the Treatment of Aseptic Femoral Nonunions.
- nail dynamization:
- plate augmentation (over nail):
- references:
- Augmentation Plate Fixation for the Treatment of Femoral and Tibial Nonunion After Intramedullary Nailing
- Effectiveness of plate augmentation for femoral shaft nonunion after nailing
- The treatment of nonisthmal femoral shaft nonunions with intramedullary nail exchange versus augmentation plating
- Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting
- Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience.
- Indications and outcomes of augmentation plating with decortication and bone grafting for femoral shaft nonunions.
- Plate augmentation for femoral nonunion: more than just a salvage tool?
- plate fixation: (see synthes distal femoral plate and discussion of plates)
- allows direct debridement of non union ends, anatomic reduction, bone grafting and compression;
- in the report by Bellabarba C, et al, the authors report on a consectutive series of 23 femoral non unions of femoral shaft
fractures treated by previous IM nailing;
- surgical treatment consisted of indirect fracture reduction techniques using 95 deg condylar blade plate;
- 21 of 23 non unions healed without further intervention (two other fractures had hardware failure);
- references:
- Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing
- Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.
- Mechanical comparison of a distal femoral side plate and a retrograde intramedullary nail.
- The use of a locked plate in the treatment of ununited femoral shaft fractures.
- The evolution of femoral shaft plating technique.
- Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing.
- Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.
- Open reduction and internal fixation of distal femoral nonunions: long-term functional outcomes following a treatment protocol.
- Management of infected femoral nonunions with a single-staged protocol utilizing internal fixation.
- Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients.
- Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions.
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