Osteosynthesis and Trauma Care 2003; 11: 97-100
DOI: 10.1055/s-2003-42331
Femur

© Georg Thieme Verlag Stuttgart · New York

Intramedullary Nailing for the Treatment of Femoral Non-Unions Following Multiple Failed Plate Fixations

T. Karachalios1 , K. Bargiotas1 , T. Moraitis1 , A. H. Zibis1 , V. Zachos1 , A. Papachristos1 , K. N. Malizos1
  • 1 Orthopaedic Department, University of Thessaly, Larisa, Greece
Further Information

Publication History

Publication Date:
24 September 2003 (online)

Abstract

Goal: The evaluation of the clinical outcome of IM nailing for the treatment of femoral shaft pseudarthrosis in patients who had multiple failed plate osteosyntheses.
Method: From January 2000 till March 2002, 18 (17 male and 1 female, mean age 37 years) patients were treated because of femoral shaft non-union in our institution. All patients had two or more failed plate osteosyntheses. There were no septic non-unions in this group. There was no segmental bone loss. In all 18 patients the implants were removed and intramedullary nailing was performed. There was extensive periosteal stripping and areas of osteonecrosis in the majority of the patients. The quality of the surrounding soft tissues was poor due to scaring. Eight femurs were grafted with autologous iliac crest bone graft. All patients were followed by serial X-rays until union.
Results: There were no postoperative complications. All pseudarthroses were healed within an average of 10.7 months (6 -14). Non-unions which received bone graft (8 out of 18) in day one, were healed faster than those which didn't. There was no re-operations among these patients. Among the remaining 10 patients 6 were grafted five to six months postoperatively and three had had nail dynamization.
Conclusions: Intramedullary nailing for femoral shaft non-unions after multiple failed plate osteosyntheses is a safe and effective method of treatment. It seems that autologous bone graft reduces healing time and re-operation rate.

References

  • 1 Banovetz J M, Sharp R, Probe R A, Robert A, Anglen J O. Titanium plate fixation: A review of implant failure.  J Orthop Trauma. 1996;  10 389-394
  • 2 Boye H B, Lipinski S W, Willey J H. Observations of nonunions of the shafts of the long bones with statistical analysis of 842 patients.  J Bone Joint Surg [Am]. 1961;  43 150-
  • 3 Brumback R J, Uwagie-Ero S, Lakatos R P, Poka A, Bathon G H, Burgess A R. Intramedullary nailing of femoral shaft fractures - Part I-II.  J Bone Joint Surg [Am]. 1988;  70 1453
  • 4 Cove J A, Lhowe D W, Jupiter J B, Siliski J M. The management of femoral diaphyseal nonunions.  J Orthop Trauma. 1997;  11 513-520
  • 5 Einhorn T A. Enhancement of fracture healing.  J Bone Joint Surg [Am]. 1995;  77 940
  • 6 Franklin J L, Winquist R A, Benirscke S K, Hansen S T. Broken intramedullary nails.  J Bone Joint Surg [Am ]. 1988;  70 1463
  • 7 Gautier E, Cordey J, Mathys R. et al .Porosity and remodelling of plated bone after internal fixation: Result of stress shielding or vascular damage?. Elsevier Science Publishers, Amsterdam 1984; 195-200
  • 8 Heiple K G, Figgie H E, Lacey S H, Figgie M P. Femoral shaft non-union treated by a fluted intramedullary rod.  Clin Orthop. 1985;  194 218
  • 9 Kempf I, Grosse A, Rigaut P. The treatment of non-infected pseudarthrosis of the femur and tibia with locked intramedullary nailing.  Clin Orthop. 1986;  212 142-154
  • 10 Klemm K W. Treatment of infected non-union and delayed union with an interlocking nail.  Clin Orthop. 1986;  212 174
  • 11 Miller M E, Ada J R, Webb L X. Treatment of infected non-union and delayed union of tibial fractures with locking intramedullary nails.  Clin Orthop. 1989;  245 233
  • 12 Muller M E, Thomas J R. Treatment of non-union in fracture of long bones.  Clin Orthop. 1979;  138 141
  • 13 Oh I, Nahingian S, Rascher J, Farrall J P. Closed intramedullary nailing for ununited femoral fractures.  Clin Orthop. 1975;  106 206
  • 14 Okhotsky V P, Souvalyan A G. The treatment of nonunion and pseudarthrosis of the long bones with thick nails.  Injury. 1978;  10 92
  • 15 Patzakis M J, Wilkins J, Wiss D A. Infection following intramedullary nailing of long bones: diagnosis and management.  Clin Orthop. 1986;  212 182
  • 16 Raikin S M, Landsman J C, Alexander V A, Froimson M I, Plaxton N A. Effect of nicotine on the rate and strength of long bone fracture healing.  Clin Orthop. 1998;  353 231-237
  • 17 Rosen H. Compression treatment of long bones pseudarthoses.  Clin Orthop. 1979;  138 154
  • 18 Rozbruch S R, Muller U, Gautier E, Ganz R. The evolution of femoral shaft plating technique.  Clin Orthop. 1998;  354 195-208
  • 19 Webb L X, Winquist R A, Hansen S T. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft.  Clin Orthop. 1986;  212 13
  • 20 Whittle A P, Wester W, Russel T A. Fatigue failure in small diameter tibial nails.  Clin Orthop. 1995;  315 119
  • 21 Winquist R A, Hansen S T, Clawson D K. Closed intramedullary nailing of femoral fractures.  J Bone Joint Surg [Am]. 1984;  66 529
  • 22 Wu C C. Treatment of femoral shaft aseptic non-union associated with plating failure: emphasis on the situation of screw breakage.  J Trauma. 2001;  51 710-713
  • 23 Wu C C, Shih C H. Treatment of 84 cases of femoral nonunion.  Acta Orthop Scand. 1992;  63 57

Theophilos Karachalios M. D.

Associate Professor in Orthopaedics

Orthopaedic Department

University Hospital of Larisa

41222 Larisa

Greece

Phone: +30/69 44 27 66 22

Email: kar@med.vth.gr