Treatment of femoral diaphyseal non-unions: Our experience

Exchange nailing and percutaneous bone grafting for management of aseptic non-union of the femur

“…There are many options available for the management of femoral shaft non-union after interlocking nailing. These include exchange nailing, dynamisation, bone grafting and plate augmentation [8][9][10][11][12] . Augmentation plating with open grafting has also been advocated by many authors 8,10,11,13 .…”

“…These include exchange nailing, dynamisation, bone grafting and plate augmentation [8][9][10][11][12] . Augmentation plating with open grafting has also been advocated by many authors 8,10,11,13 . In distal third fractures, exchange nailing may not be able to resist rotational movement, and hence many authors tried to improve the rotational stability by supplementary fixation with a sixor eight-holed plate and open bone grafting 8,10,11,14,15 .…”

“…Augmentation plating with open grafting has also been advocated by many authors 8,10,11,13 . In distal third fractures, exchange nailing may not be able to resist rotational movement, and hence many authors tried to improve the rotational stability by supplementary fixation with a sixor eight-holed plate and open bone grafting 8,10,11,14,15 . Plate augmentation retaining the original nail provides stability at the fracture site and prevents excessive motion that leads to hypertrophic non-union 11 .…”

“…Fractures are known to heal faster with a reamed nail 10,16 . Exchange nailing has been reported as the preferred method of treatment of non-union after femoral nailing with success rate varying from 100% 7,11 , 78.3% 17 , to 53% 18 .…”

“…Many techniques have been described for bone grafting along with exchange nailing. This includes open autogenous iliac crest grafting 6,8,9,20 , percutaneous bone grafting 14,23-25 , and percutaneous bone marrow implantation 10,[26][27][28] . Over reaming of the canal produces between 60 and 80 ml of graft with a one-time passage of a large diameter reamer tip 29 , as proved with a reamer-irrigator-aspirator system.…”