title: Effect of reaming bone grafting on treating femoral shaft aseptic nonunion after plating.
abstract: Rigid intramdullary nailing with cancellous bone grafting provided by intramedullary reaming was prospectively used to treat femoral shaft aseptic nonunions after plating. Indications for this technique were a femoral shaft nonunion with an inserted plate, no previous infection sign in the treatment course, less than 1.5 cm shortening, and no segmental bony defects. After the plate was removed, a flexible guidewire was inserted antegradely. The local wound was closed, and intramedullary reaming was done as widely as possible until some resistance to it occurred. Finally, a rigid intramedullary nail was inserted. Twenty-four consecutive patients were treated with this regimen, and 21 were followed-up for at least 1 year (range 1-5 years). All 21 nonunions healed with a union rate of 100% (21/21). The time to union was 4.5 +/- 1.0 months. There were no significant complications. We conclude that for indicated cases, reaming bone grafting is a very effective technique and avoided donor site morbidity. Therefore, whenever possible, this technique could be considered first.
authors.affiliation: Department of Orthopedics, Chang Gung Memorial Hospital, 5 Fu-Hsin St. 333, Kweishan, Taoyuan, Taiwan. ccwu@cguaplo.cgu.edu.tw
authors.forename: C C
authors.initials: CC
authors.lastname: Wu
authors.forename: C H
authors.initials: CH
authors.lastname: Shih
authors.forename: W J
authors.initials: WJ
authors.lastname: Chen
authors.forename: C L
authors.initials: CL
authors.lastname: Tai
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D016896:Treatment Outcome