title: Treatment of diaphyseal nonunion of the femur and tibia using an expandable nailing system.
abstract: BACKGROUND
  We evaluated the efficacy of the expandable nailing system for treating femur and tibia shaft nonunions.
  
  
  METHODS
  Records of 24 patients (25 fractures) were retrospectively reviewed: 16 with femur and 8 with tibia nonunions. The bones underwent reaming, and the largest possible nail sizes were inserted during re-operation. Bone debris obtained from the reaming was used for bone graft at the site of the nonunion.
  
  
  RESULTS
  The mean age of the patients was 32 years for the tibia group and 49 years for the femur group. The respective intervals between trauma and re-operation were 11 and 13 months, the operation times 60 and 78 min, and the fluoroscopy times 21 and 32s. Twenty-four of the 25 nonunions healed satisfactorily without requiring additional procedures. In 1 case, demineralised bone matrix was injected percutaneously and the femoral nonunion resolved. Healing time was 23 weeks (6-52) and 17 weeks (6-40) in the tibia and femur groups, respectively. We were able to reduce the need of an autologous bone graft to only two cases by using reamed debris in 17 of the 19 patients who required grafting.
  
  
  CONCLUSIONS
  Our results demonstrated satisfactory healing for the treatment of diaphyseal nonunions of the femur and tibia. The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. We recommend expandable nail systems for femur and tibia shaft nonunions and the use of reamed debris in order to decrease the use of autogenous bone graft.
authors.affiliation: Department of Orthopaedic Surgery B, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv 64239, Israel. eli_st@netvision.net.il
authors.forename: Ely L
authors.initials: EL
authors.lastname: Steinberg
authors.forename: Ori
authors.initials: O
authors.lastname: Keynan
authors.forename: Amir
authors.initials: A
authors.lastname: Sternheim
authors.forename: Michael
authors.initials: M
authors.lastname: Drexler
authors.forename: Elhanan
authors.initials: E
authors.lastname: Luger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001858:Bone Nails; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome