title: Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients.
abstract: BACKGROUND
  The management of femoral shaft nonunion still remains a challenge in orthopaedic surgery. It represents a serious postoperative problem for the patient, associated with plate breakage and loosening, bone defect, shortening deformity and infection. A double plate fixation combined with bone grafting may become a promising therapeutic strategy for the treatment of patients with femoral shaft nonunion. In this study, our goal was to evaluate the clinical outcome of a novel approach for 14 consecutive patients with femoral shaft nonunion using double plate fixation with bone grafting.
  
  
  METHODS
  Retrospective data from June 2010 to August 2012 were obtained from records for 14 consecutive femoral shaft aseptic nonunion patients treated with double plate fixation combined with bone grafting. Nine patients were men and five patients were woman and average age of the patients was 26 years (range from 22 to 32 years). The mean time since injury was 26.2 months. The nonunion had resulted from repeated internal fixation failure (including plate or intramedullary nail fixation) in nine cases and primary internal fixation in five cases.
  
  
  RESULTS
  All the 14 patients were followed up for an average of 14.8 (10-25) months. All cases achieved bony union without wound infection or fixation failure and the mean time to union was 5.2 months (range 4-7 months).
  
  
  CONCLUSIONS
  Double plate fixation and bone grafting are a promising method for femoral shaft nonunion. In addition, this strategy is useful for such a nonunion caused by a repeated plate or intramedullary nail fixation failure with bone defect due to its strong stability with three-dimensional fixation and fully bone graft availability.
authors.affiliation: Department of Joint Surgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China.
authors.forename: Asihaerjiang
authors.initials: A
authors.lastname: Maimaitiyiming
authors.affiliation: Department of Joint Surgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China.
authors.forename: Abdusami
authors.initials: A
authors.lastname: Amat
authors.affiliation: Department of VIP Surgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China.
authors.forename: Aili
authors.initials: A
authors.lastname: Rehei
authors.affiliation: Department of Joint Surgery, Urumqi General Hospital of Lanzhou Military Region, Urumqi, Xinjiang, China.
authors.forename: Mamatkeremula
authors.initials: M
authors.lastname: Tusongjiang
authors.affiliation: Department of Joint Surgery, First Affiliated Hospital, Xinjiang Medical University, Urumqi, Xinjiang, China. Electronic address: caolixjmu@163.com.
authors.forename: Cao
authors.initials: C
authors.lastname: Li
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation; D002681:China / Q000453:epidemiology; D005260:Female; D005264:Femoral Fractures / Q000473:pathology / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods; D005599:Fractures, Ununited / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Bone grafting; Double plate fixation; Femoral shaft; Nonunion; Treatment