title: Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting.
abstract: BACKGROUND
  Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects.
  
  
  METHODS
  Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted.
  
  
  RESULTS
  The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain.
  
  
  CONCLUSIONS
  The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.
authors.affiliation: Department of Orthopaedics, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai 200433, People's Republic of China.
authors.forename: Yunfei
authors.initials: Y
authors.lastname: Niu
authors.forename: Yushu
authors.initials: Y
authors.lastname: Bai
authors.forename: Shuogui
authors.initials: S
authors.lastname: Xu
authors.forename: Xinwei
authors.initials: X
authors.lastname: Liu
authors.forename: Panfeng
authors.initials: P
authors.lastname: Wang
authors.forename: Dajiang
authors.initials: D
authors.lastname: Wu
authors.forename: Chuncai
authors.initials: C
authors.lastname: Zhang
authors.forename: Ming
authors.initials: M
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007085:Ilium / Q000601:surgery; D015601:Injury Severity Score; D007869:Leg Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult