Is removal of a nail and re-osteosynthesis necessary for all un-united femoral shaft fracture? (Abstract no:43413)  Raju Vaishya, Amit Kumar Agarwal , Nishint Gupta, Vipul Vijay Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India

Rotational instability, in the presence of a nail, Non-union after intramedullary nail fixation of femur shaft fractures leaves one in a challenging situation. Rotational instability, in the presence of a nail, is one of the main reasons for most non-union

How to deal with such situation ? EXCHANGE NAILING (Most accepted but inconsistent result) (not favourable for distal femur fractures) NAIL REMOVAL AND PLATE FIXATION (Extensive soft tissue and vascular compromise) DYNAMISATION (Results Unreliable) ILIZAROV FIXATION (Troublesome and Time consuming ) PLATE AUGMENTATION WITH NAIL IN SITU (author’s preferred treatment)

Methods and Material Retrospectively, 16 cases of the femoral shaft nonunion (after interlocking nail) were included. “Plate augmentation and bone grafting (if needed) with retention of the intramedullary interlocking nail in situ” was done. Infected non union and duration of less then one year were excluded.

RESULTS Average time to radiographic union of 6.25 months (range 4–9 months). All sixteen cases achieved union. Bone grafting was done only in 4 cases with atrophic non-union. The average time of surgery between the primary surgery of interlocking nail fixation and the plate augmentation was 13 months (range 12–15 months). Mean surgical time 71 min (range 55–95 min). Average range of motion of the knee was 115 degree (range 100–135) An average residual shortening of the limb was 0.9 cm . No major complication or implant failure was encountered.

Pros & cons of various procedures

Discussion: Plate augmentation allows additional rotational stability at the fracture site. Plate holds the fragments in place thus preventing their micro motion (Choi and Kim et al.) Studies have shown results comparable to the present study.

CONCLUSION Plate augmentation for femoral shaft non-union after intramedullary nailing seems an : effective reliable safe and an easy procedure . Conflicts of interest The authors have none to declare.

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