Osteoperiosteal decortication and bone grafting combined with wave plating for femoral shaft aseptic atrophic nonunion after intramedullary nailing

Abstract

Objective Femoral shaft nonunion after intramedullary nailing fixation remains a challenge for orthopedic surgeons. This study evaluated osteoperiosteal decortication and iliac bone grafting combined with wave plating as a treatment for aseptic atrophic nonunion of the femoral shaft after intramedullary nailing. Methods The study included 22 patients (two female, 20 male; mean age 40.8 years [range, 19–61]) with aseptic atrophic nonunion of the femoral shaft who underwent osteoperiosteal decortication and iliac bone grafting combined with wave plating between January 2016 and January 2020. Cases with infected nonunion, hypertrophic nonunion, and nonunion after plate osteosynthesis were excluded. Clinical outcomes were assessed retrospectively using the Samantha X-ray and Paley scale scores. Results The mean follow-up period was 18.8 months (range, 12–35). Bone union was achieved in all patients. The average clinical healing time was 5.7 months (range, 3–14). The mean Samantha X-ray score was 5.7 ± 0.45 and the Paley scores indicated excellent or good clinical results in all cases. One patient developed sterile wound leakage that resolved after a dressing change. Conclusions Osteoperiosteal decortication and bone grafting combined with wave plating is an excellent treatment for aseptic atrophic nonunion of the femoral shaft after intramedullary nailing.

Plate augmentation and hybrid bone grafting are effective treatments for atrophic nonunion of the femur with the original intramedullary nail retained in situ

“…In our experience, extensive removal of inactive cortical bone could refresh the nonunion site, resulting in large bone defects. Other studies 17 , 27 , 28 have used a decortication technique to remove fibrous tissue and sclerotic bone at the nonunion site, but this method lacks clear standardization and relies mainly on a surgeon's personal experience. To overcome these challenges and avoid large bone defects, our study utilized a hybrid bone grafting technique that simplifies the process and provides greater standardization.…”

What Is the Best Treatment of the Femoral Shaft Nonunion after Intramedullary Nailing? A Systematic Review

“…A total of 558 of 611 patients (96.3%) achieved bone consolidation, in a mean time of 8.26 ± 6.12. A complete (100%) bone healing was reported in 10 studies [13,[16][17][18][19][20][23][24][25]28]; in three studies, bone healing rate was reported between 95% and 100% [15,22,27]; and in three studies, bone healing rate was less than 95% [14,21,26].…”

“…Of the 16 studies selected, 14 were retrospective [13][14][15][16][17][18][19][20][21][22][23][24][25][26] and 2 were prospective [27,28]. Overall, data from 632 patients were analyzed in our systematic review (summarized data are reported on Table 1).…”

“…In 61 patients, nonunion was treated with a revision of the intramedullary nail associated with autologous bone grafting [13,25]. Pseudoarthrosis was treated in 24 patients, with the maintenance of the intramedullary nail associated with plate and screw implantation [20,22], while in 231 patients, the maintenance of the intramedullary nail was associated with plate and screw implantation and autologous bone grafting (in 210 patients) [14][15][16]21,24,26,28] or xenogenic bone grafting (in 21 patients) [18]. In 115 patients, nonunion was treated with an intramedullary nail revision associated with plate and screw implantation and autologous bone grafting [19,22,23].…”