title: Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing.
abstract: OBJECTIVE
  To observe and report the clinical results of indirect plating techniques in the treatment of femoral shaft nonunions originally treated with intramedullary nailing.
  
  
  METHODS
  Prospective consecutive.
  
  
  METHODS
  Regional trauma center.
  
  
  METHODS
  A consecutive series of twenty-three patients with nonunion of femoral shaft fractures previously treated with intramedullary nailing.
  
  
  METHODS
  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 nonunions of the middle one third, with selective autologous cancellous bone grafting. 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.
  
  
  METHODS
  Healing rate and time, operative blood loss and time, and incidence of complications, including hardware failure, loss of fixation, infection, and postoperative malalignment.
  
  
  RESULTS
  Twenty-one of the twenty-three nonunions healed without further intervention at an average of twelve weeks (range 10 to 16 weeks) postoperatively. The two remaining patients (9 percent) had early breakage of their hardware, requiring repeat plating. Union in both of these cases occurred within sixteen weeks of the revision (12 and 16 weeks). Including the two patients requiring reoperation, all twenty-three nonunions healed at an average of seventeen weeks (range 10 to 24 weeks) from the initial plating procedure. There were no intraoperative complications. Average operative time was 164 minutes (range 120 to 240 minutes), and blood loss was 340 milliliters (range 200 to 700 milliliters). There were no cases of significant postoperative axial or rotational malalignment (more than 5 degrees), limb length discrepancy (more than 1 centimeter), or deep infections.
  
  
  CONCLUSIONS
  Modern plating techniques are effective in the treatment of femoral shaft nonunions after intramedullary fracture fixation. The authors consider this method particularly valuable in the presence of deformity. Union occurred reliably with few complications.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, Harborview Medical Center, Seattle, Washington 98104, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bellabarba
authors.forename: W M
authors.initials: WM
authors.lastname: Ricci
authors.forename: B R
authors.initials: BR
authors.lastname: Bolhofner
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D016025:Bone Transplantation; D018483:Diaphyses / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome