title: Treatment of femoral shaft aseptic nonunion associated with broken distal locked screws and shortening.
abstract: BACKGROUND
  This retrospective study investigated the treatment of femoral shaft aseptic nonunions associated with broken distal locked screws and shortening.
  
  
  METHODS
  In this study, 11 femoral shaft aseptic nonunions associated with both broken distal locked screws and shortening in 11 consecutive adult patients were treated. All nonunions were associated with at least 1.5 cm (range, 1.5-3.5 cm) shortening. These nonunions were treated by removal of locked nails, one-stage femoral lengthening, static locked nail stabilization, and corticocancellous bone graft supplementation. Postoperatively, ambulation with protected weightbearing was encouraged as early as possible.
  
  
  RESULTS
  Ten nonunions were followed up for a median of 4.1 years (range, 1.8-5.5 years), and nine fractures healed at a median of 4 months (range, 3-6 months). The nonunion case had broken locked screws again at 5 months and was treated with exchange nailing. The fracture healed uneventfully at 4 months. No other complications occurred.
  
  
  CONCLUSIONS
  The key to removal of broken screws is withdrawal of the nail slightly to release the incarcerated broken screw end. The screw end then is pushed out with a used Knowles' pin or a smaller screwdriver under image intensifier guidance. Concomitant one-stage femoral lengthening to treat nonunion with shortening has a high success rate.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.forename: Zhon-Liau
authors.initials: ZL
authors.lastname: Lee
mesh_terms: D000328:Adult; D001863:Bone Screws; D004868:Equipment Failure; D005240:Feasibility Studies; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects*; D005599:Fractures, Ununited / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies