title: Intramedullary fixation of failed plated femoral diaphyseal fractures: are bone grafts necessary?
abstract: BACKGROUND
  Nonunited fracture shaft femur after plate fixation is a common problem in third world countries because of economic reasons. Management of such a problem is still controversial and is associated with many surgical details, due not only to the nonunited fracture itself, but also to the broken implant which is not easy to remove.
  
  
  METHODS
  This study is a randomized prospective study presenting 40 patients with aseptic nonunited fracture shaft femur associated with failed plating managed by the removal of hardware, and intramedullary fixation using an interlocking nail with or without autogenous iliac bone graft.
  
  
  RESULTS
  There was no statistically significant difference between patients with and without iliac autogenous bone graft regarding the demographic data, the preoperative condition, and the postoperative course including time needed for bone union and return to work. The statistically significant difference was in the intraoperative blood loss and the duration of surgery with less blood loss and shorter duration of surgery occurring in the group treated by reamed intramedullary nail without iliac bone graft.
  
  
  CONCLUSIONS
  In cases with aseptic nonunited fracture shaft femur after failed plating, intramedullary reamed nailing without autogenous bone graft produced similar results as with bone graft, but with less operating time and blood loss.
authors.affiliation: Department of Orthopedic Surgery, Ain Shams University, Cairo, Egypt. kmemara@hotmail.com
authors.forename: Khaled M
authors.initials: KM
authors.lastname: Emara
authors.forename: Mohamed Farouk
authors.initials: MF
authors.lastname: Allam
mesh_terms: D000328:Adult; D001860:Bone Plates; D015331:Cohort Studies; D020878:Device Removal; D018483:Diaphyses / Q000293:injuries; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D012086:Reoperation; D017211:Treatment Failure