Results of indirect reduction and plating of femoral shaft nonunions afterintramedullary nailing

Objective: To observe and report the clinical results of indirect plating t echniques in the treatment of femoral shaft nonunions originally treated wi th intramedullary nailing. Design: prospective consecutive. Setting: Regional trauma center. Patients: A consecutive series of twenty-three patients with nonunion of fe moral shaft fractures previously treated with intramedullary nailing. Intervention: Surgical treatment with indirect plating techniques using the AO 95-degree condylar blade plate in nonunions of the distal and proximal one thirds and broad large-fragment dynamic compression plating: in nonunio ns of the middle one third, with selective autologous cancellous bone graft ing. Emphasis was placed on preoperative planning. intraoperative attention to soft tissue sparing and selection of the appropriately applied implant to correct deformity and obtain union. Main Outcome Measurements: Healing rate and time, operative blood loss and time, and incidence of complications, including hardware failure, loss of f ixation, infection, and postoperative malalignment. Results: Twenty-one of the twenty-three nonunions healed without further. i ntervention Lit an average of twelve weeks (range 10 to 16 weeks) postopera tively. The two remaining patients (9 percent) had early breakage of their hardware, requiring repeat plating. Union in both of these cases occurred w ithin sixteen weeks of the revision (12 and 16 weeks). Including the two pa tients requiring reoperation, all twenty-three nonunions healed at an avera ge of seventeen weeks (range 10 to 24 weeks) from the initial plating proce dure. There were no intraoperative complications. Average operative time wa s 164 minutes (range 120 to 240 minutes), and blood loss was 340 milliliter s (range 200 to 700 milliliters). There were no cases of significant postop erative axial or rotational malalignment (more than 5 degrees), limb length discrepancy (more than I centimeter), or deep infections. Conclusions: Modern plating techniques an effective in the treatment of fem oral shaft nonunions after intramedullary fracture fixation. The authors co nsider this method particularly valuable in the presence of deformity. Unio n occurred reliably with few complications.