title: Femoral non-union with malalignment: reconstruction and biological stimulation with the chipping technique.
abstract: BACKGROUND
  The purpose of this study was to investigate the effectiveness of the chipping technique for the treatment of femoral non-unions associated with malalignment.
  
  
  METHODS
  A total of 21 femoral non-unions were managed with the chipping procedure and re-fixation. 15 of them had malalignment (angular or rotational deformity or limb length discrepancy). The deformities were simultaneously corrected by a combination of chipping and temporal external fixator. The median age of patients were 41 years (range, 19-73 years). The median time from injury or the final surgery to the initial chipping procedure was 24 months (range: 9-240 months). Femoral non-unions were classified as hypertrophic in 9, oligotrophic in 5 and atrophic in 7. Clinical and radiological assessment was performed.
  
  
  RESULTS
  All femoral non-unions radiographically healed with one (19 cases) or two (2 cases) chipping procedures without bone grafting. Pre-existing angular deformity was corrected from 14° to 2°, external rotation 27° to 0°, and limb length discrepancy 16-7 mm. There were no major complications, although swelling of thigh and anemia was common after surgery.
  
  
  CONCLUSIONS
  Chipping the non-union site was associated with a favorable outcome. It biologically enhances fracture healing and should be considered as a treatment option for femoral non-unions with malalignment.
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan. Electronic address: fracture@zad.att.ne.jp.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsushita
mesh_terms: D000328:Adult; D000368:Aged; D017760:Bone Malalignment / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chipping technique; Femoral non-union; Fracture healing; Malalignment