Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study.
OBJECTIVE
The purpose of this study was to compare the outcomes of exchanging reamed nailing (ERN) and augmentative compression plating (ACP) with autogenous bone grafting (BG) for the treatment of aseptic femoral shaft nonunion secondary to the treatment of intramedullary nailing (IMN).


METHODS
A multicenter retrospective study was performed for 178 patients (180 cases) of aseptic femoral shaft nonunion secondary to first treatment of IMN. All cases were fixed with either ERN (n=87) or ACP (n=93). In the ERN group, 42 cases (48.3%) were nonisthmal nonunions and 45 (51.7%) were isthmal nonunions. In the ACP group, 46 cases (49.5%) were nonisthmal nonunions, and 47 (50.5%) were isthmal nonunions. Operation time, blood loss, time to union, union rate, volume of drainage, time to renonunion, and complication rate were compared between the 2 groups.


RESULTS
All patients were followed up, with a mean period of 4.1 years (range: 1-7.1 years). Bone union occurred in 93/93 cases (100%) in the ACP group versus 75/87 cases (86.2%) in the ERN group (odds ratio [OR]=3.28, 95% confidence interval [CI] 0.8-14). Of the 12 cases involved with renonunion in the ERN group, 10 were nonisthmal nonunions, and 2 were isthmal nonunions with cortical bone defect >3 cm. The union time, blood loss, and complication rate of the ERN group were significantly higher than those of the ACP group (p=0.028, p=0.035, and p=0.021, respectively). No significant difference was found in the average operation time of the 2 groups (p=0.151). However, for the nonisthmal nonunions, a significant difference was found between the ERN and ACP groups (p=0.018).


CONCLUSIONS
ACP with autogenous BG can obtain a higher bone union rate and shorter time to union than ERN in the treatment of aseptic femoral shaft nonunion after failed IMN. Especially for nonisthmal femoral shaft nonunions or isthmal nonunions with larger bone defects, ACP with autogenous BG can be more advantageous than ERN for patients. A future prospective observational study should be conducted.
Nanjing University Faculty of Medicine, Jinling Hospital, Department of Orthopaedics, Nanjing, China.
Jiang-Ying
JY
Ru
Changhai Hospital Affiliated to Second Military Medical University, Department of Orthopedics, Shanghai, China.
Yun-Fei
YF
Niu
Nanjing University Faculty of Medicine, Jinling Hospital, Department of Orthopaedics, Nanjing, China.
Yu
Y
Cong
Nanjing University Faculty of Medicine, Jinling Hospital, Department of Orthopaedics, Nanjing, China.
Wen-Bo
WB
Kang
Jiangsu Provincial Corps Hospital of the Chinese People's Armed Police Force, Department of Orthopaedics, Yangzhou, China.
Hai-Bin
HB
Cang
Nanjing University Faculty of Medicine, Jinling Hospital, Department of Orthopaedics, Nanjing, China.
Jian-Ning
JN
Zhao
D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D018483:Diaphyses / Q000601:surgery*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome