Use of locking compression plates for long bone nonunions without removing existing intramedullary nail: review of literature and our experience.
BACKGROUND
Exchange nailing of ununited fractures with or without bone grafting is the most acceptable procedure for nonunion with previously implanted intramedullary nails. Though excellence of this procedure has been well documented for diaphyseal, noncomminuted fractures of long bones, its acceptability for distal femoral, metaphyseal-diaphyseal junctional fractures, and humeral locations is doubtful. A method of obtaining stability at fracture site is described wherein locking compression plates are applied over the ununited fracture with bone grafting without removal of the underlying nail.


METHODS
Eleven patients (six males, five females) with ununited fracture of long bones were enrolled. All these patients had previously undergone locked intramedullary nailing for fractures of long bones (seven femur, two humerus, two tibia). Fracture site was exposed, surfaces rawed, and locking compression plate (AO Synthes) was applied over the intramedullary nail. Eccentric position of the plate allowed one or two bicortical screws adding to the stability of the construct. Interlocking screws if broken were also replaced during the same sitting. Autologous bone grafting was done in all cases.


RESULTS
All fractures showed radiologic union at 6.2 months. No complications were encountered.


CONCLUSIONS
Locking compression plating of ununited fracture with preexisting intramedullary nails has predictable good results for specific indications.
Nadkarni
Biren
B
Delhi Institute of Trauma and Orthopaedics, Sant Parmanand Hospital, New Delhi, India. birennad@hotmail.com
Srivastav
Shekhar
S
Mittal
Vivek
V
Agarwal
Shekhar
S
D000328:Adult; D000368:Aged; D001858:Bone Nails; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary; D018460:Fractures, Comminuted / Q000601:surgery*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013978:Tibial Fractures / Q000601:surgery*