Plate Augmentation in Aseptic Femoral Shaft Nonunion after Intramedullary Nailing: A Literature Review

Abstract

Background: Femoral shaft fractures (FSFs) are a frequent injury in traumatology for which intramedullary nailing (IMN) is considered the gold standard treatment. Nonunion (NU) is one of the most frequent complications in FSF treated with IMN, with a percentage from 1.1% to 14%. Plate augmentation (PA), the addition of a compression plate and screws, with or without bone graft has been described as an effective option for the treatment of NU, improving the biomechanical conditions at the fracture site. The aim of this review was to analyze the literature relating to the use of PA in NU after IMN in FSFs to assess the efficacy of the technique. Methods: An electronic search on PubMed, Google Scholar, and Web of Science was conducted to search for all studies concerning PA of femoral shaft NUs after IMN. Results: Twenty-four studies were included in the review comprising a total of 502 patients with a mean age of 39.5 years. Of these, 200 hundred patients had atrophic pseudoarthrosis and 123 had hypertrophic pseudoarthrosis, while in 179, the type of pseudoarthrosis was not reported. The most frequently used plate for PA was the dynamic compression plate (DCP); in 87.1% of the cases, the authors added a bone graft to the plate fixation. In 98.0% of the patients, a complete bone union was achieved in a mean time of 5.8 ± 2.12 months. Conclusion: The patients treated with PA included in this review showed a good rate of consolidation in the femoral shaft NUs, with good functional recovery and a low incidence of complications.

Accordion maneuver with Ilizarov placed plate in situ, in a case of femoral shaft non-union and refracture with quiescent infection, discussion on treatment strategies: a case report

“…9 The gold standard treatment for femoral shaft fracture is intramedullary nailing (IMN) with low post-operative complications -infection rate 1.2 to 5%, non-union 8%, broken nail, reaming trauma and technical difficulties but when plate is used complications are more -wide range of surgical trauma, infection 5%, non-union 19% and broken or bending of plate. 5,[10][11][12][13] Closed intra-medullary nail (IMN) fixation provide more benefit of mechanical stability, low bleeding and less surgical damage which reduces risk of infection compared to plate fixation. 10 Plate fixation is suitable in comminuted fracture shaft of femur and minimally invasive plate osteo-synthesis (MIPO) procedure preserve vascularity and soft tissue which facelifted bone healing.…”

“…union are the morbid complications of femur fractures-infection rate 0.4 and non-union 1.1 to 14%. 5,6 There are several treatment options in fracture shaft of femur but no standard guidelines. The gold standard treatment for femoral shaft fracture is intramedullary nailing (IMN).…”

Trochanteric and subtrochanteric fractures irreducible by closed reduction: a retrospective study

“…Modern implants for intramedullary fixation allow immediate weight bearing in most cases. Despite these achievements in implant design, the complication rates are still very high [ 8 – 10 ]. Many factors are associated with complications, including the fracture pattern, bone quality, reduction quality, and implant placement [ 8 ].…”

Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series

“…It represents a serious postoperative complication for the patient, associated with longer time of restricted mobility, shortening, deformity, knee joint stiffness and the need for second major surgery, providing osteosynthesis plus bone graft after failed plate removal [8] . Intramedullary nailing is the gold standard for femoral shaft fracture, with good union results and a success rate up to 95 % [9] . The aim of this series is to evaluate the effectiveness of IM nailing for treating aseptic femoral shaft nonunions after failed plating.…”