title: Plate augmentation with retention of intramedullary nail is effective for resistant femoral shaft non-union.
abstract: OBJECTIVE
  Non-union after intramedullary nail fixation of femur shaft fractures is although infrequent but a challenging condition to treat. The treatment options available to deal with such a situation include exchange nailing, removal of nail and re-osteosynthesis with plating, or Ilizarov fixation. We believe that rotational instability, in the presence of a nail, is one of the main reasons for most of the non-union. We present our experience of plate augmentation leaving the nail in situ for non-union of femoral shaft fracture.
  
  
  METHODS
  In this retrospective study, we had operated 16 cases of the femoral shaft non-union, which were treated by plate augmentation and bone grafting (if needed) with retention of the intramedullary interlocking nail in situ. The cases of infected non-union and any fracture less than one-year duration were excluded from the study.
  
  
  RESULTS
  Bone grafting was done only in 4 cases with atrophic non-union. We could achieve union in all the cases at an average time of 6.25 months. The average time of surgery between the primary surgery of interlocking nail fixation and the plate augmentation was 13 months. Mean surgical time for plate augmentation and bone grafting was 71 min. No major complication or implant failure was encountered. An average residual shortening of the limb was 0.9 cm and average range of motion of the knee was 115°.
  
  
  CONCLUSIONS
  Plate augmentation seems an effective, reliable, safe and an easy procedure for the treatment of femoral shaft non-union after an intramedullary nailing.
authors.affiliation: Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India.
authors.forename: Raju
authors.initials: R
authors.lastname: Vaishya
authors.affiliation: Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Agarwal
authors.affiliation: Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India.
authors.forename: Nishint
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi 110076, India.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
keywords: Femur; Fracture; Intramedullary nail; Non-union; Plate