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Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study

Year 2015, Volume: 49 Issue: 6, 668 - , 28.10.2015

Abstract

Objective: The purpose of this study was to compare the outcomes of exchanging reamed nailing (ERN) and augmentative compression plating (ACP) with autogenous bone grafting (BG) for the treatment of aseptic femoral shaft nonunion secondary to the treatment of intramedullary nailing (IMN).
Methods: A multicenter retrospective study was performed for 178 patients (180 cases) of aseptic femoral shaft nonunion secondary to first treatment of IMN. All cases were fixed with either ERN (n=87) or ACP (n=93). In the ERN group, 42 cases (48.3%) were nonisthmal nonunions and 45 (51.7%) were isthmal nonunions. In the ACP group, 46 cases (49.5%) were nonisthmal nonunions, and 47 (50.5%) were isthmal nonunions. Operation time, blood loss, time to union, union rate, volume of drainage, time to renonunion, and complication rate were compared between the 2 groups.
Results: All patients were followed up, with a mean period of 4.1 years (range: 1–7.1 years). Bone union occurred in 93/93 cases (100%) in the ACP group versus 75/87 cases (86.2%) in the ERN group (odds ratio [OR]=3.28, 95% confidence interval [CI] 0.8–14). Of the 12 cases involved with renonunion in the ERN group, 10 were nonisthmal nonunions, and 2 were isthmal nonunions with cortical bone defect >3 cm. The union time, blood loss, and complication rate of the ERN group were significantly higher than those of the ACP group (p=0.028, p=0.035, and p=0.021, respectively). No significant difference was found in the average operation time of the 2 groups (p=0.151). However, for the nonisthmal nonunions, a significant difference was found between the ERN and ACP groups (p=0.018).
Conclusion: ACP with autogenous BG can obtain a higher bone union rate and shorter time to union than ERN in the treatment of aseptic femoral shaft nonunion after failed IMN. Especially for nonisthmal femoral shaft nonunions or isthmal nonunions with larger bone defects, ACP with autogenous BG can be more advantageous than ERN for patients. A future prospective observational study should be conducted.

 

DOI: 10.3944/AOTT.2015.14.0404

References

  • Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, MacDonald DA, Smith RM. Exchange nailing for femoral shaft aseptic non-union. Injury 1999;30:245–9.
  • Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma 1999;46:392–9.
  • Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or de- layed union. J Orthop Trauma 2000;14:178–82.
  • Pihlajamäki HK, Salminen ST, Böstman OM. The treat- ment of nonunions following intramedullary nailing of fem- oral shaft fractures. J Orthop Trauma 2002;16:394–402.
  • Wu CC. Exchange nailing for aseptic nonunion of femo- ral shaft: a retrospective cohort study for effect of reaming size. J Trauma 2007;63:859–65.
  • Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA. The outcome of closed, intramedullary exchange nail- ing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma 2009;23:653–7.
  • Oh JK, Bae JH, Oh CW, Biswal S, Hur CR. Treat- ment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft. Injury 2008;39:952–9.
  • Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trau- ma 2000;14:335–8.
  • Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury 2003;34:349–56.
  • Yang KH, Kim JR, Park J. Nonisthmal femoral shaft non- union as a risk factor for exchange nailing failure. J Trau- ma Acute Care Surg 2012;72:E60–4.
  • Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with im nail ex- change versus augmentation plating. J Orthop Trauma 2010;24:89–94.
  • Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury 2007;38 Suppl 2:19–22.
  • Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology 1983;58:277–80.
  • Court-Brown CM, Keating JF, Christie J, McQueen MM. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br 1995;77:407–11.
  • Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indo- methacin and antibodies to insulin-like growth factors. J Orthop Trauma 2002;16:717–22.
  • Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 1997;43:640–4.
  • Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlock- ing nail. J Trauma 1998;45:747–52.
  • Park K, Kim K, Choi YS. Comparison of mechanical ri- gidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop 2011;35:581–5.
  • Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft frac- tures. Int Orthop 2005;29:287–90.
  • Lin CJ, Chiang CC, Wu PK, Chen CF, Huang CK, Su AW, et al. Effectiveness of plate augmentation for femoral shaft nonunion after nailing. J Chin Med Assoc 2012;75:396– 401.
  • Said GZ, Said HG, el-Sharkawi MM. Failed intramedul- lary nailing of femur: open reduction and plate augmenta- tion with the nail in situ. Int Orthop 2011;35:1089–92.
  • Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh- Chabock H. Augmentation plate fixation for the treat- ment of femoral and tibial nonunion after intramedullary nailing. Orthopedics 2009;32:409.
  • Chen CM, Su YP, Hung SH, Lin CL, Chiu FY. Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture. Orthopedics 2010;33:393.
  • Hakeos WM, Richards JE, Obremskey WT. Plate fixation of femoral nonunions over an intramedullary nail with au- togenous bone grafting. J Orthop Trauma 2011;25:84–9.
  • Gao KD, Huang JH, Tao J, Li F, Gao W, Li HQ, Wang QG. Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft. Orthop Surg 2011;3:83–7.
  • Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of lock- ing compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 2008;65:482–6.
  • Ye J, Zheng Q. Augmentative locking compression plate fixation for the management of long bone nonunion af- ter intramedullary nailing. Arch Orthop Trauma Surg 2012;132:937–40.
  • Park J, Yang KH. Indications and outcomes of augmenta- tion plating with decortication and autogenous bone graft- ing for femoral shaft nonunions. Injury 2013;44:1820–5.
Year 2015, Volume: 49 Issue: 6, 668 - , 28.10.2015

Abstract

References

  • Furlong AJ, Giannoudis PV, DeBoer P, Matthews SJ, MacDonald DA, Smith RM. Exchange nailing for femoral shaft aseptic non-union. Injury 1999;30:245–9.
  • Wolinsky PR, McCarty E, Shyr Y, Johnson K. Reamed intramedullary nailing of the femur: 551 cases. J Trauma 1999;46:392–9.
  • Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or de- layed union. J Orthop Trauma 2000;14:178–82.
  • Pihlajamäki HK, Salminen ST, Böstman OM. The treat- ment of nonunions following intramedullary nailing of fem- oral shaft fractures. J Orthop Trauma 2002;16:394–402.
  • Wu CC. Exchange nailing for aseptic nonunion of femo- ral shaft: a retrospective cohort study for effect of reaming size. J Trauma 2007;63:859–65.
  • Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA. The outcome of closed, intramedullary exchange nail- ing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma 2009;23:653–7.
  • Oh JK, Bae JH, Oh CW, Biswal S, Hur CR. Treat- ment of femoral and tibial diaphyseal nonunions using reamed intramedullary nailing without bone graft. Injury 2008;39:952–9.
  • Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trau- ma 2000;14:335–8.
  • Banaszkiewicz PA, Sabboubeh A, McLeod I, Maffulli N. Femoral exchange nailing for aseptic non-union: not the end to all problems. Injury 2003;34:349–56.
  • Yang KH, Kim JR, Park J. Nonisthmal femoral shaft non- union as a risk factor for exchange nailing failure. J Trau- ma Acute Care Surg 2012;72:E60–4.
  • Park J, Kim SG, Yoon HK, Yang KH. The treatment of nonisthmal femoral shaft nonunions with im nail ex- change versus augmentation plating. J Orthop Trauma 2010;24:89–94.
  • Frölke JP, Patka P. Definition and classification of fracture non-unions. Injury 2007;38 Suppl 2:19–22.
  • Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology 1983;58:277–80.
  • Court-Brown CM, Keating JF, Christie J, McQueen MM. Exchange intramedullary nailing. Its use in aseptic tibial nonunion. J Bone Joint Surg Br 1995;77:407–11.
  • Bhandari M, Schemitsch EH. Bone formation following intramedullary femoral reaming is decreased by indo- methacin and antibodies to insulin-like growth factors. J Orthop Trauma 2002;16:717–22.
  • Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma 1997;43:640–4.
  • Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlock- ing nail. J Trauma 1998;45:747–52.
  • Park K, Kim K, Choi YS. Comparison of mechanical ri- gidity between plate augmentation leaving the nail in situ and interlocking nail using cadaveric fracture model of the femur. Int Orthop 2011;35:581–5.
  • Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft frac- tures. Int Orthop 2005;29:287–90.
  • Lin CJ, Chiang CC, Wu PK, Chen CF, Huang CK, Su AW, et al. Effectiveness of plate augmentation for femoral shaft nonunion after nailing. J Chin Med Assoc 2012;75:396– 401.
  • Said GZ, Said HG, el-Sharkawi MM. Failed intramedul- lary nailing of femur: open reduction and plate augmenta- tion with the nail in situ. Int Orthop 2011;35:1089–92.
  • Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh- Chabock H. Augmentation plate fixation for the treat- ment of femoral and tibial nonunion after intramedullary nailing. Orthopedics 2009;32:409.
  • Chen CM, Su YP, Hung SH, Lin CL, Chiu FY. Dynamic compression plate and cancellous bone graft for aseptic nonunion after intramedullary nailing of femoral fracture. Orthopedics 2010;33:393.
  • Hakeos WM, Richards JE, Obremskey WT. Plate fixation of femoral nonunions over an intramedullary nail with au- togenous bone grafting. J Orthop Trauma 2011;25:84–9.
  • Gao KD, Huang JH, Tao J, Li F, Gao W, Li HQ, Wang QG. Management of femoral diaphyseal nonunion after nailing with augmentative locked plating and bone graft. Orthop Surg 2011;3:83–7.
  • Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of lock- ing compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience. J Trauma 2008;65:482–6.
  • Ye J, Zheng Q. Augmentative locking compression plate fixation for the management of long bone nonunion af- ter intramedullary nailing. Arch Orthop Trauma Surg 2012;132:937–40.
  • Park J, Yang KH. Indications and outcomes of augmenta- tion plating with decortication and autogenous bone graft- ing for femoral shaft nonunions. Injury 2013;44:1820–5.
There are 28 citations in total.

Details

Primary Language English
Journal Section Original Article
Authors

Ru Jiang-ying This is me

Niu Yun-fei This is me

Cong Yu This is me

Kang Wen-bo This is me

Cang Hai-bin This is me

Zhao Jian-ning This is me

Publication Date October 28, 2015
Published in Issue Year 2015 Volume: 49 Issue: 6

Cite

APA Jiang-ying, R., Yun-fei, N., Yu, C., Wen-bo, K., et al. (2015). Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthopaedica Et Traumatologica Turcica, 49(6), 668. https://doi.org/10.3944/AOTT.2015.14.0404
AMA Jiang-ying R, Yun-fei N, Yu C, Wen-bo K, Hai-bin C, Jian-ning Z. Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthopaedica et Traumatologica Turcica. October 2015;49(6):668. doi:10.3944/AOTT.2015.14.0404
Chicago Jiang-ying, Ru, Niu Yun-fei, Cong Yu, Kang Wen-bo, Cang Hai-bin, and Zhao Jian-ning. “Exchanging Reamed Nailing Versus Augmentative Compression Plating With Autogenous Bone Grafting for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study”. Acta Orthopaedica Et Traumatologica Turcica 49, no. 6 (October 2015): 668. https://doi.org/10.3944/AOTT.2015.14.0404.
EndNote Jiang-ying R, Yun-fei N, Yu C, Wen-bo K, Hai-bin C, Jian-ning Z (October 1, 2015) Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthopaedica et Traumatologica Turcica 49 6 668.
IEEE R. Jiang-ying, N. Yun-fei, C. Yu, K. Wen-bo, C. Hai-bin, and Z. Jian-ning, “Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study”, Acta Orthopaedica et Traumatologica Turcica, vol. 49, no. 6, p. 668, 2015, doi: 10.3944/AOTT.2015.14.0404.
ISNAD Jiang-ying, Ru et al. “Exchanging Reamed Nailing Versus Augmentative Compression Plating With Autogenous Bone Grafting for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study”. Acta Orthopaedica et Traumatologica Turcica 49/6 (October 2015), 668. https://doi.org/10.3944/AOTT.2015.14.0404.
JAMA Jiang-ying R, Yun-fei N, Yu C, Wen-bo K, Hai-bin C, Jian-ning Z. Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthopaedica et Traumatologica Turcica. 2015;49:668.
MLA Jiang-ying, Ru et al. “Exchanging Reamed Nailing Versus Augmentative Compression Plating With Autogenous Bone Grafting for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study”. Acta Orthopaedica Et Traumatologica Turcica, vol. 49, no. 6, 2015, p. 668, doi:10.3944/AOTT.2015.14.0404.
Vancouver Jiang-ying R, Yun-fei N, Yu C, Wen-bo K, Hai-bin C, Jian-ning Z. Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthopaedica et Traumatologica Turcica. 2015;49(6):668.