[Augmentive plate fixation in femoral non-unions after intramedullary nailing. Strategy after unsuccessful intramedullary nailing of the femur].

INTRODUCTION: Intramedullary nailing is a standard procedure to treat femoral fractures in patients without polytrauma. Nevertheless, non-union in femoral fractures is a common complication with an incidence of 12.5 percent, mostly arising for mechanical reasons. The aim of this study is to find out whether the increase of stability through an augmentive plate fixation (if necessary with bone grafting) with leaving the nail in situ is adequate to treat the non-union successfully.

MATERIALS AND METHODS: Between January 2001 and July 2005 32 patients with femoral non-unions after intramedullary nailing were treated in our hospital. Mean age was 42 years (min 22 and max 75). Distribution of gender was about (2/3) male and (1/3) female. In 17 patients the fractures were localised in the middle of the femur shaft, in 8 patients in the proximal third and in 7 in the distal third. The results were evaluated retrospectively by reviewing the patients' records and X-ray-films. If the success of treatment was not clearly determined through the records the patients were contacted by telephone and, if required, invited for a personal examination.

RESULTS: In 29 cases our procedure led primarily to a definite consolidation of the non-union within 5 months on average. The nail was changed eight times, in three patients an additional operation was necessary due to screw breakage. Bone grafting was performed in 27 cases. The overall group included 24 non-smokers and 8 smokers.

CONCLUSION: If indicated, the herein demonstrated procedure with an augmentive plate fixation while leaving the nail in situ is simple and safe. Although the intramedullary canal is potentially affected through the initial nailing, the healing of femoral non-unions was observed in the majority of cases in spite of the additional extramedullary approach for plating and bone grafting.