title: Is augmentation plating an effective treatment for non-union of femoral shaft fractures with nail in situ?
abstract: OBJECTIVE
  There are few reports of non-union femur shaft fractures treated with plate fixation with the nail in situ. This study reports our results in 40 cases.
  
  
  METHODS
  Retrospective series of non-union and delayed union of femoral shaft after intramedullary nailing treated with plate fixation. Patients were serially followed-up till 12 months. Fracture union, time to union, knee range of motion, deformity, shortening and complications were recorded. Descriptive statistics were performed as applicable.
  
  
  RESULTS
  There were 40 patients with mean age of 35 years (18-65). There were 14 cases of hypertrophic non-union, 24 cases of atrophic non-union and 2 cases of delayed union. The average time of surgery was 1 ½ h and average blood loss was 300 ml. Exchange nailing was done in 9 cases. Union was achieved in 39 patients. The mean time to fracture union was 4 months. Post-operative knee range of motion was >120° in 35 patients. One patient developed deep infection which was treated with removal of implants and exchange nailing with a vancomycin coated nail and union was achieved.
  
  
  CONCLUSIONS
  Plating is an effective treatment for non-union of diaphyseal femur fractures after intramedullary fixation with the nail in situ.
authors.affiliation: Department of Orthopaedics, Bombay Hospital Postgraduate Institute of Medical Sciences, Marine Lines, Mumbai, India.
authors.forename: H R
authors.initials: HR
authors.lastname: Jhunjhunwala
authors.affiliation: Department of Orthopaedics, Bombay Hospital Postgraduate Institute of Medical Sciences, Marine Lines, Mumbai, India. arjundhawale@hotmail.com.
authors.forename: A A
authors.initials: AA
authors.lastname: Dhawale
mesh_terms: D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology*; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Femur; Fracture; Nail; Nonunion; Osteosynthesis; Plate