COMPARISON OF TWO SURGICAL METHODS FOR ASEPTIC NONUNIONS OF FEMORAL SHAFT FRACTURES AFTER FEMORAL NAILING_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

RU Jiangying , CANG Haibin , HU Chuanliang , HU Yuhua.

Department of Orthopaedic Surgery, Jiangsu Provincial Corps Hospital of the Chinese People’s Armed Police Force, Yangzhou Jiangsu, 225003, P.R.China. Corresponding author: RU Jiangying, E-mail: rujiangying@163.com;

Corresponding author：

Keywords：

Femoral shaft fracture; Intramedullary nail internal fixation; Aseptic nonunion; Complication

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Objective To compare the outcomes between intramedullary nail change and augmentation plating with a retained intramedullary nail for aseptic nonunion of femoral shaft fractures after femoral nailing, and to analyze the cause so as to guide the clinical application. Methods Between June 2001 and June 2011, 28 patients with aseptic nonunion of femoral shaft fractures after femoral nailing were treated with intramedullary nail change (11 patients, group A) and augmentation plating with a retained intramedullary nail (17 patients, group B), and the clinical data were analyzed retrospectively. There was no significant difference in age, gender, smoking, location of fracture, Association for the Study of Internal Fixation (AO/ASIF) classification, type of injury, associated injury, type of nonunion, and time of nonunion between 2 groups (P gt; 0.05). The patients were followed up by imaging and the clinical function at regular intervals to observe the callus growth and the recovery condition of the affected limb function, and clinical curative effectiveness was evaluated by Tohner-Wrnch standard. Results The operation time, intraoperative bleeding volume, and intraoperative erythrocyte-transported volume in group A were significantly higher than those in group B (P lt; 0.05). There was no significant difference in postoperative drainage volume and hospitalization days between 2 groups (P gt; 0.05). All the incisions healed by first intention, and no nerve and blood vessel injury occurred. All patients were followed up 18.6 months on average (range, 12-36 months). All cases obtained bone union, and time of clinical and radiological bone healing in group B was significantly shorter than those in group A (P lt; 0.05). During follow-up, no following complication occurred: deep incision infection, injuries of blood vessels and nerves, loosening and breakage of internal fixation, loss of reduction, angulated and rotational malunion. According to Tohner-Wrnch standard at last follow-up, the results were excellent in 6 cases, good in 3 cases, and poor in 2 cases, with an excellent and good rate of 81.8% in group A; the results were excellent in 12 cases, good in 5 cases, with an excellent and good rate of 100% in group B; and difference was significant between 2 groups (Z= — 2.623, P=0.021). Conclusion Augmentation plating with a retained intramedullary nail is an ideal treatment for aseptic nonunion of femoral shaft fractures after femoral nailing and can achieve satisfactory clinical outcomes because it has simpler operation, shorter operation time, less blood loss, and less trauma than intramedullary nail change.

Citation： RU Jiangying,CANG Haibin,HU Chuanliang,HU Yuhua.. COMPARISON OF TWO SURGICAL METHODS FOR ASEPTIC NONUNIONS OF FEMORAL SHAFT FRACTURES AFTER FEMORAL NAILING. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(1): 25-29. doi: Copy

1.	Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma, 2002, 16(6): 394-402.
2.	Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
3.	Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
4.	Johanson NA, Liang MH, Daltroy L, et al. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg (Am), 2004, 86-A(5): 902-909.
5.	Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
6.	赵刚, 张伯松, 孙林, 等. 带锁髓内针治疗股骨干骨折术后旋转不稳定所致不愈合的诊断和治疗. 中华外科杂志, 2009, 47(16): 1232-1235.
7.	Johner R, Raccaud O, Dournow J. Standard radiological study of the knee. Rev Med Suisse Romande, 1994, 114(4): 335-341.
8.	李宝文, 王东昕, 李学良, 等. 股骨干骨折术后不愈合25例临床分析. 中国修复重建外科杂志, 2008, 22(6): 763-764.
9.	Court-Brown CM, Keating JF, Christie J, et al. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg (Br), 1995, 77(3): 407-411.
10.	Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indomethacin and antibodies to insulin-like growth factors. J Orthop Trauma, 2002, 16(10): 717-722.
11.	刘振东. 扩髓换钉治疗股骨干无菌性骨不连. 中华创伤骨科杂志, 2005, 7(5): 470-472.
12.	Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic nonunion: not the end to all problems. Injury, 2003, 34(5): 349-356.
13.	Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
14.	Park K, Kim K, Choi YS, et al. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop, 2011, 35(4): 581-585.
15.	Nadkarni B, Srivastav S, Mittal V, et al. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma, 2008, 65(2): 482-486.
16.	张建政, 刘智, 孙天胜, 等. 附加钢板治疗髓内钉固定后股骨萎缩性骨不连. 中华创伤杂志, 2011, 27(5): 451-455.
17.	刘智, 李连华, 孙天胜, 等. 附加钢板与交锁髓内钉治疗下肢长骨干骨折后肥大性骨不连22例. 中华创伤杂志, 2011, 27(8): 702-704.
18.	Lin CJ, Chiang CC, Wu PK, et al. Effectiveness of plate augmentation for femoral shaft nounion after nailing. J Chin Med Assoc, 2012, 75(8): 396-401.
19.	Said GZ, Said HG, el-Sharkawi MM, et al. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop, 2011, 35(7): 1089-1092.
20.	张建政, 孙天胜, 刘智, 等. 更换髓内钉与保留髓内钉附加钢板治疗髓内钉固定后股骨肥大性骨不连. 中华骨科杂志, 2011, 31(9): 949-954.

1. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma, 2002, 16(6): 394-402.
2. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
3. Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
4. Johanson NA, Liang MH, Daltroy L, et al. American Academy of Orthopaedic Surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Joint Surg (Am), 2004, 86-A(5): 902-909.
5. Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury, 2007, 38 Suppl 2: S19-22.
6. 赵刚, 张伯松, 孙林, 等. 带锁髓内针治疗股骨干骨折术后旋转不稳定所致不愈合的诊断和治疗. 中华外科杂志, 2009, 47(16): 1232-1235.
7. Johner R, Raccaud O, Dournow J. Standard radiological study of the knee. Rev Med Suisse Romande, 1994, 114(4): 335-341.
8. 李宝文, 王东昕, 李学良, 等. 股骨干骨折术后不愈合25例临床分析. 中国修复重建外科杂志, 2008, 22(6): 763-764.
9. Court-Brown CM, Keating JF, Christie J, et al. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg (Br), 1995, 77(3): 407-411.
10. Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indomethacin and antibodies to insulin-like growth factors. J Orthop Trauma, 2002, 16(10): 717-722.
11. 刘振东. 扩髓换钉治疗股骨干无菌性骨不连. 中华创伤骨科杂志, 2005, 7(5): 470-472.
12. Banaszkiewicz PA, Sabboubeh A, McLeod I, et al. Femoral exchange nailing for aseptic nonunion: not the end to all problems. Injury, 2003, 34(5): 349-356.
13. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
14. Park K, Kim K, Choi YS, et al. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop, 2011, 35(4): 581-585.
15. Nadkarni B, Srivastav S, Mittal V, et al. Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma, 2008, 65(2): 482-486.
16. 张建政, 刘智, 孙天胜, 等. 附加钢板治疗髓内钉固定后股骨萎缩性骨不连. 中华创伤杂志, 2011, 27(5): 451-455.
17. 刘智, 李连华, 孙天胜, 等. 附加钢板与交锁髓内钉治疗下肢长骨干骨折后肥大性骨不连22例. 中华创伤杂志, 2011, 27(8): 702-704.
18. Lin CJ, Chiang CC, Wu PK, et al. Effectiveness of plate augmentation for femoral shaft nounion after nailing. J Chin Med Assoc, 2012, 75(8): 396-401.
19. Said GZ, Said HG, el-Sharkawi MM, et al. Failed intramedullary nailing of femur: open reduction and plate augmentation with the nail in situ. Int Orthop, 2011, 35(7): 1089-1092.
20. 张建政, 孙天胜, 刘智, 等. 更换髓内钉与保留髓内钉附加钢板治疗髓内钉固定后股骨肥大性骨不连. 中华骨科杂志, 2011, 31(9): 949-954.

Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF TWO SURGICAL METHODS FOR ASEPTIC NONUNIONS OF FEMORAL SHAFT FRACTURES AFTER FEMORAL NAILING

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