title: Augmentative locking plate with autologous bone grafting for distal femoral nonunion subsequent to failed retrograde intramedullary nailing.
abstract: OBJECTIVE
  To explore the indications and efficacy of augmentative locking compression plate (LCP) or less invasive stabilization system (LISS)with autogenous bone grafting (BG) in treating distal femoral nonunion subsequent to failed retrograde intramedullary nailing (RIN).
  
  
  METHODS
  A retrospective study was performed for 21 patients with distal femoral nonunion subsequent to failed RIN, who received therapy with either augmentative LCP (n = 11) or LISS with autogenous BG (n = 13). Operation time, time to union, union rate, time to renonunion, complication rate and SF-36 scores a year after hardware removal were compared between the two groups.
  
  
  RESULTS
  The bone union occurred in 13/13 (100%) cases in augmentative LISS group versus 9/11 (81.8%) cases in augmentative LCP group [odds ratio (OR) = 3.21, 95% confidence interval (CI) 0.7-13]. Time to union, time to renonunion, complication rate of the augmentative LCP group were significantly more than that of the augmentative LISS with autogenous BG group (p = 0.023, p = 0.021 and p = 0.033). No significant difference was found in the average operation time of two groups (p = 0.121). At the follow-up a year after hardware removal, statistically significant HRQOL improvement in the augmentive LISS group was measured at the level of pain (p = 0.003) and general health perception (p = 0.011), as compared to the augmentive LCP group.
  
  
  CONCLUSIONS
  We suggest augmentative LCP, for distal femoral nonunios after RIN, may be optimal for that of typeAO33A fractures, whereas augmentative LISS for that of typeAO33C fractures more.
authors.affiliation: Department of Orthopaedics, The First People's Hospital of Yangzhou City, The Second Clinical School of Yangzhou University, Yangzhou 225000, Jiangsu province, People's Republic of China.
authors.forename: Jiang-Ying
authors.initials: JY
authors.lastname: Ru
authors.affiliation: Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, People's Republic of China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cong
authors.affiliation: Department of Orthopaedics, The First People's Hospital of Yangzhou City, The Second Clinical School of Yangzhou University, Yangzhou 225000, Jiangsu province, People's Republic of China.
authors.forename: Dai
authors.initials: D
authors.lastname: Shi
authors.affiliation: Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai 200433, People's Republic of China.
authors.forename: Yang-Hu
authors.initials: YH
authors.lastname: Lu
authors.affiliation: Department of Orthopedics, Changhai Hospital Affiliated to Second Military Medical University, Shanghai 200433, People's Republic of China. Electronic address: nyunfei1219@163.com.
authors.forename: Yun-Fei
authors.initials: YF
authors.lastname: Niu
authors.affiliation: Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, People's Republic of China.
authors.forename: Hai-Dong
authors.initials: HD
authors.lastname: Xu
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Augmentative locking plate; Autologous bone grafting; Distal femoral nonunion; Retrograde intramedullary nailing