Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion

Hasan Basri Pınar

Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion

Abstract

Aims: Femoral shaft fractures (FSFs) are commonly treated with intramedullary nailing (IMN), the current gold standard. Although nonunion after IMN is uncommon, it remains a challenging complication. This study evaluated the outcomes of augmentation plating (AP) with autologous iliac crest bone grafting (AICBG) without nail exchange for aseptic femoral shaft nonunion following IMN. Methods: This retrospective study included 24 patients treated for aseptic femoral shaft nonunion after IMN between 2024 and 2026. Nonunion was defined as the absence of radiographic healing 6 months after the index procedure. Patients with infection, implant failure, bilateral fractures, or bone defects >3 cm were excluded. All patients underwent AP using a 4.5-mm dynamic compression plate combined with AICBG without nail exchange and were followed for at least 12 months. Results: The median age was 44.5 (37.0-54.5) years, and 20 patients (83.3%) were male. Motor vehicle accidents were the most common injury mechanism, and 12 patients had open fractures. Nonunion was located in the distal third in six patients and in the middle or proximal third in 18. Seven patients had atrophic nonunion, whereas 17 had oligotrophic or hypertrophic nonunion. Previous interventions included dynamization (n=4) and nail exchange (n=2). Radiographic solid union was achieved in all patients at a median of 5.0 (4.0-7.5) months. Median operative time was 60.0 (50.0-60.0) minutes. No major complications or implant failures occurred during a median follow-up of 14.0 (12.0-16.0) months. Conclusion: AP combined with AICBG while retaining the intramedullary nail was associated with radiographic union in all patients in this series and may represent a useful treatment option for selected patients with aseptic femoral shaft nonunion following IMN.

Keywords

Ethical Statement

Ethical approval was obtained from Clinical Research Ethics Committee of Gazi Yaşargil Training and Research Hospital, University of Health Sciences (Approval No: 215; Date: 13.05.2026).

References

Marti RK, Kloen P; AO Education AO Foundation. Concepts and cases in nonunion treatment (AO Trauma Handbooks), 1st ed. Switzerland: Thieme Verlag; 2011.
Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE. Risk factors for femoral nonunion after femoral shaft fracture. J Trauma. 2009;67(6):1389-1392. doi:10.1097/TA.0b013e318182afd0
Canadian Orthopaedic Trauma Society. Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial. J Bone Joint Surg Am. 2003; 85(11):2093-2096.
Giannoudis PV, MacDonald DA, Matthews SJ, Smith RM, Furlong AJ, De Boer P. Nonunion of the femoral diaphysis. The influence of reaming and non-steroidal anti-inflammatory drugs. J Bone Joint Surg Br. 2000;82(5):655-658. doi:10.1302/0301-620x.82b5.9899
Vaughn J, Gotha H, Cohen E, et al. Nail dynamization for delayed union and nonunion in femur and tibia fractures. Orthopedics. 2016;39(6): e1117-e1123. doi:10.3928/01477447-20160819-01
Agrawal HK, Garg M, Singh B, et al. Management of complex femoral nonunion with monorail external fixator: a prospective study. J Clin Orthop Trauma. 2016;7(Suppl 2):191-200. doi:10.1016/j.jcot.2016.02.013
Javadi Reyhaneh. Exchange reamed nailing compared to augmentation compression plating in treatment of femoral shaft non-union. Doctoral thesis, Mazandaran University of Medical Sciences. 2020.
Somford MP, van den Bekerom MPJ, Kloen P. Operative treatment for femoral shaft nonunions, a systematic review of the literature. Strategies Traum Limb Reconstr. 2013;8(2):77-88. doi:10.1007/s11751-013-0168-5

Smith WR, Morgan SJ. Failure of internal ﬁxation of the femoral shaft. Tech Orthop. 2002;17(4):448-457.
Menon DK, Dougall TW, Pool RD, Simonis RB. Augmentative Ilizarov external ﬁxation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma. 2002;16(7):491-497. doi:10.1097/00005131-200208000-00007
Birjandinejad A, Ebrahimzadeh MH, Ahmadzadeh-Chabock H. Augmentation plate ﬁxation for the treatment of femoral and tibial nonunion after intramedullary nailing. 2009;32(6):409. doi:10.3928/01477447-20090511-12
Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate ﬁxation for the management of femoral nonunion after intramedullary nailing. J Trauma. 1997;43(4):640-644. doi:10.1097/00005373-199710000-00013
Chiang JC, Johnson JE, Tarkin IS, Siska PA, Farrell DJ, Mormino MA. Plate augmentation for femoral nonunion: more than just a salvage tool? Arch Orthop Trauma Surg. 2016;136(2):149-156. doi:10.1007/s00402-015-2365-9
Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures. Int Orthop. 2005;29(5): 287-290. doi:10.1007/s00264-005-0668-0
Vaishya R, Agarwal AK, Gupta N, Vijay V. Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union. J Orthop. 2016;13(4):242-245. doi:10.1016/j.jor.2016.06.003
Luo H, Su Y, Ding L, Xiao H, Wu M, Xue F. Exchange nailing versus augmentative plating in the treatment of femoral shaft nonunion after intramedullary nailing: a meta-analysis. EFORT Open Rev. 2019;4(8): 513-518. doi:10.1302/2058-5241.4.180054
Hak DJ, Lee SS, Goulet JA. Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union. J Orthop Trauma. 2000;14(3):178-182. doi:10.1097/00005131-200003000-00005
Litrenta J, Tornetta P 3rd, Vallier H, et al. Dynamizations and exchanges: success rates and indications. J Orthop Trauma. 2015;29(12):569-573. doi:10.1097/BOT.0000000000000311
Park KC, Oh CW, Kim JW, et al. Minimally invasive plate augmentation in the treatment of long-bone non-unions. Arch Orthop Trauma Surg. 2017;137(11):1523-1528. doi:10.1007/s00402-017-2773-0
Park J, Yang KH. Indications and outcomes of augmentation plating with decortication and autogenous bone grafting for femoral shaft nonunions. Injury. 2013;44(12):1820-1825. doi:10.1016/j.injury.2013.02.021
Sancheti KH, Pradhan C, Patil A, et al. Effectiveness of exchange K-nail and augmented plating in aseptic femoral diaphyseal non-union. Injury. 2017;48(Suppl 2):S61-S65. doi:10.1016/S0020-1383(17)30496-5
Wang SR, Yu JY, Wang YH, Wang PZ, Tan HL. Augmenting locking plate with autologous bone graft for the treatment of nonunion of long bone fracture in the lower extremity with retaining of the original intramedullary nail. Zhongguo Gu Shang. 2023;36(12):1191-1195. doi:10.12200/j.issn.1003-0034.2023.12.016
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 Trauma. 2000;14(5):335-338. doi:10.1097/00005131-200006000-00005
Medlock G, Stevenson IM, Johnstone AJ. Uniting the un-united: should established non-unions of femoral shaft fractures initially treated with IM nails be treated by plate augmentation instead of exchange IM nailing? A systematic review. Strategies Trauma Limb Reconstr. 2018; 13(3):119-128. doi:10.1007/s11751-018-0323-0

Details

Primary Language

English

Subjects

Orthopaedics

Journal Section

Research Article

Authors

Hasan Basri Pınar ^*
0000-0003-2004-9461
Türkiye

Publication Date

October 25, 2026

Submission Date

July 8, 2026

Acceptance Date

September 26, 2026

Published in Issue

Year 2026 Volume: 7 Number: 5

IZ

https://izlik.org/JA35AP79XH

Cite

RIS / Bibtex

APA

Pınar, H. B. (2026). Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion. Journal of Medicine and Palliative Care, 7(5), 1085-1090. https://izlik.org/JA35AP79XH

AMA

1.Pınar HB. Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion. J Med Palliat Care / JOMPAC / jompac. 2026;7(5):1085-1090. https://izlik.org/JA35AP79XH

Chicago

Pınar, Hasan Basri. 2026. “Clinical Outcomes of Augmentation Plating Without Nail Exchange in Aseptic Femoral Shaft Nonunion”. Journal of Medicine and Palliative Care 7 (5): 1085-90. https://izlik.org/JA35AP79XH.

EndNote

Pınar HB (October 1, 2026) Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion. Journal of Medicine and Palliative Care 7 5 1085–1090.

IEEE

[1]H. B. Pınar, “Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 5, pp. 1085–1090, Oct. 2026, [Online]. Available: https://izlik.org/JA35AP79XH

ISNAD

Pınar, Hasan Basri. “Clinical Outcomes of Augmentation Plating Without Nail Exchange in Aseptic Femoral Shaft Nonunion”. Journal of Medicine and Palliative Care 7/5 (October 1, 2026): 1085-1090. https://izlik.org/JA35AP79XH.

JAMA

1.Pınar HB. Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion. J Med Palliat Care / JOMPAC / jompac. 2026;7:1085–1090.

MLA

Pınar, Hasan Basri. “Clinical Outcomes of Augmentation Plating Without Nail Exchange in Aseptic Femoral Shaft Nonunion”. Journal of Medicine and Palliative Care, vol. 7, no. 5, Oct. 2026, pp. 1085-90, https://izlik.org/JA35AP79XH.

Vancouver

1.Hasan Basri Pınar. Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion. J Med Palliat Care / JOMPAC / jompac [Internet]. 2026 Oct. 1;7(5):1085-90. Available from: https://izlik.org/JA35AP79XH