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The Treatment of Nonisthmal Femoral Shaft Nonunions With IM Nail Exchange Versus Augmentation Plating

Objectives: The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. Design: Retrospective data analysis, November 1996-March 2006. Setting: A level I trauma center. Patients: Eighteen patients with 18 nonisthmal femoral nonunions. Intervention: Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Main Outcome Measure: Union and complications. Results: Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). Conclusions: AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.