title: Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions.
abstract: OBJECTIVE
  To evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Fifty aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ an average of 25 months after the initial fracture nailing were evaluated.
  
  
  METHODS
  Our systematic approach includes inserting an exchange nail at least 2 mm larger in diameter than the in situ nail, using a different manufacturer's nail, static interlocking, correction of any metabolic and endocrine abnormalities, and secondary nail dynamization in cases showing slow progression toward healing.
  
  
  METHODS
  The outcome measures were radiographic and clinical evidence of nonunion healing and time to union.
  
  
  RESULTS
  All 50 femoral nonunions (100%) healed after this systematic approach to exchange nailing. The average time to achieve union was 7 months (range, 3-26 months).
  
  
  CONCLUSIONS
  Utilization of this systematic approach of exchange nailing for the treatment of aseptic femoral nonunions resulted in a 100% healing rate.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors: *Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX; †Department of Orthopaedic Trauma, The University of Texas Medical School at Houston, Houston, TX; ‡Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX; and §Department of Health and Human Performance, University of Houston, Houston, TX.
authors: Eli A
authors: EA
authors: Swanson
authors: Eli C
authors: EC
authors: Garrard
authors: Derek T
authors: DT
authors: Bernstein
authors: Daniel P
authors: DP
authors: OʼConnor
authors: Mark R
authors: MR
authors: Brinker
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D020878:Device Removal; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult