title: Dual implant application in the treatment of aseptic femoral shaft nonunions--case series.
abstract: BACKGROUND
  Femoral shaft nonunion is not uncommon in orthopaedic practice in the developing economy and it can pose a management challenge. There is no single standard method of treatment.
  
  
  OBJECTIVE
  To report four patients with femoral shaft nonunion treated by dual implant application in a private Orthotrauma practice in Port Harcourt, Nigeria.
  
  
  METHODS
  The first patient was a 50-year-old retroviral positive male with right femoral nonunion who had implant failure (Kuntscher nail breakage) after initial Kuntscher nailing. The second patient was a 38-year-old female who had Kuntscher nail migration following intramedullary nailing for left femoral fracture. Subsequently she had plate fixation which failed. The third patient was a 39-year-old male who was managed by traditional bone setters for a left femoral fracture. He had Kuntscher nailing but due to poor callus activity and shortening, he had a revision surgery. The fourth patient was a 26-year-old female who had left femoral shaft nonunion after initial Kuntscher nailing. She subsequently had an exchange nailing but did not achieve bony union. All the injuries were road accident related. All four patients had dual implant application (intramedullary nailing with plate and screw augmentation) and went on to bony union.
  
  
  CONCLUSIONS
  Intramedullary nailing augmented with plate fixation is a useful and efficient method for treatment of femoral shaft nonunion. The technique is simple and does not require special instrumentation.
authors.affiliation: Division of Orthopaedics, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
authors.forename: A U
authors.initials: AU
authors.lastname: Ekere
authors.forename: R C
authors.initials: RC
authors.lastname: Echem
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005269:Femur / Q000473:pathology / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*