Augmentative antirotational plating provided a significantly higher union rate than exchanging reamed nailing in treatment for femoral shaft aseptic atrophic nonunion - retrospective cohort study

Abstract

BackgroundAtrophic nonunion of femoral shaft fracture after intramedullary (IM) nailing is uncommon. The treatment for femoral shaft aseptic atrophic non-union remained controversial. The aim of this study was to compare the surgical results between exchanging reamed nailing (ERN) and augmentative antirotational plating (AAP) for femoral shaft aseptic atrophic nonunion.MethodsWe retrospectively reviewed the patients with femoral shaft nonunion between the year of 2014 and 2015. The patients with nonunion after plate osteosynthesis, septic nonunion, hypertrophic nonunion, additional surgery during revision surgery were excluded. All the patients were followed up at least 12 months.ResultsOverall, the union rate after revision surgery was 70.8%. The union rate was significantly higher in the AAP group than in the ERN group. Operating time was also significantly shorter in the AAP group. Regarding the location of nonunion, the union rate was comparable between groups for isthmic nonunions. However, for non-isthmic nonunions, the union rate was significantly higher and operating time was significantly shorter in the AAP group.ConclusionAAP showed an overall higher union rate for management of femoral shaft aseptic atrophic nonunion compared with ERN. Especially for non-isthmic femoral shaft atrophic nonunions, AAP provided a significantly higher union rate and significantly shorter operating time.

Comparing Augmentative Plating and Exchange Nailing for the Treatment of Nonunion of Femoral Shaft Fracture after Intramedullary Nailing: A Meta‐analysis

“…Blood loss volume was reported in three studies, with 466 patients (217 in the AP group and 249 in the EN group). In view of the obvious heterogeneity in these results ( I 2 = 98%), we adopt the random‐effects model.…”

“…Five studies of 508 patients (232 from the AP group and 276 from the EN group) reported the number of complications (including infection and re‐nonunion). Overall, data collected using a fixed‐effects model (M‐H Fixed) ( I 2 = 86%) and the study showed that the number of complications was significantly lower in the AP group than in the EN group ( OR , −0.11; 95% CI , −0.16 to −0.07; P < 0.01) (Fig.…”

“…Besides, we extracted postoperative indications from this study, including union rate, union time, and incidence of complications. The pooled analysis from five studies indicated that the AP group had a significantly higher union rate than the EN group ( P < 0.01). Lai et al .…”

“…The pooled analysis from five studies indicated that the AP group had a significantly higher union rate than the EN group ( P < 0.01). Lai et al . concluded that AP provided a significantly higher union rate than EN in treatment for femoral shaft aseptic nonunion.…”

“…Five trials [9][10][11][12][13] were assessed using the Cochrane Handbook, and the risk of bias of included studies is shown in Fig. 2 and summarized in Fig.…”