[Recent Advances in Treatment of Aseptic Femoral Shaft Nonunion]

Overview

Journal Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi

Specialty General Surgery

Date 2018 May 29

PMID 29806336

Citations 3

Authors

Wei Zhang

Hua Chen

Peifu Tang

Affiliations

Soon will be listed here.

Abstract

Objective: To review the recent advances in treatment of aseptic femoral shaft nonunion.

Methods: The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed.

Results: There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial.

Conclusion: Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

Citing Articles

Clinical Outcomes of Treatment Strategies for Postoperative Plate Fracture and In Situ Fracture of the Femoral Shaft.

Tu J, Jiang H, Li C, Huang X, Li X Biomed Res Int. 2022; 2022:8145438.

PMID: 36060150 PMC: 9439913. DOI: 10.1155/2022/8145438.

[Research progress of augmentation plate for femoral shaft nonunion after intramedullary nail fixation].

Zhang W, Zhang Z, Chen H Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019; 33(12):1467-1473.

PMID: 31823542 PMC: 8355795. DOI: 10.7507/1002-1892.201903073.

Clinical outcomes of femoral shaft non-union: dual plating versus exchange nailing with augmentation plating.

Zhang W, Zhang Z, Li J, Zhang L, Chen H, Tang P J Orthop Surg Res. 2018; 13(1):295.

PMID: 30458810 PMC: 6247613. DOI: 10.1186/s13018-018-1002-z.

References

Murray W, Lucas D, INMAN V . TREATMENT OF NON-UNION OF FRACTURES OF THE LONG BONES BY THE TWO-PLATE METHOD. J Bone Joint Surg Am. 1964; 46:1027-48. View

Maimaitiyiming A, Amat A, Rehei A, Tusongjiang M, Li C . Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury. 2015; 46(6):1102-7. DOI: 10.1016/j.injury.2015.01.009. View

Ueng S, Shih C . Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma. 1998; 45(4):747-52. DOI: 10.1097/00005373-199810000-00021. View

Healey J, Zimmerman P, McDonnell J, Lane J . Percutaneous bone marrow grafting of delayed union and nonunion in cancer patients. Clin Orthop Relat Res. 1990; (256):280-5. View

Brinker M, OConnor D . Exchange nailing of ununited fractures. J Bone Joint Surg Am. 2007; 89(1):177-88. DOI: 10.2106/JBJS.F.00742. View

Yang K, Kim J, Park J . Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure. J Trauma Acute Care Surg. 2012; 72(2):E60-4. DOI: 10.1097/TA.0b013e318239caca. View

Crowley D, Kanakaris N, Giannoudis P . Femoral diaphyseal aseptic non-unions: is there an ideal method of treatment?. Injury. 2007; 38 Suppl 2:S55-63. DOI: 10.1016/s0020-1383(07)80010-6. View

Weresh M, Hakanson R, Stover M, Sims S, Kellam J, Bosse M . Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma. 2000; 14(5):335-8. DOI: 10.1097/00005131-200006000-00005. View

Bell A, Templeman D, Weinlein J . Nonunion of the Femur and Tibia: An Update. Orthop Clin North Am. 2016; 47(2):365-75. DOI: 10.1016/j.ocl.2015.09.010. View

10.

Schulz A, Faschingbauer M, Seide K, Schuemann U, Mayer M, Jurgens C . Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate. Eur J Trauma Emerg Surg. 2016; 35(2):127-31. DOI: 10.1007/s00068-008-8009-9. View

11.

Masquelet A, Fitoussi F, Begue T, Muller G . [Reconstruction of the long bones by the induced membrane and spongy autograft]. Ann Chir Plast Esthet. 2000; 45(3):346-53. View

12.

Abdel-Aa A, Farouk O, Elsayed A, Said H . The use of a locked plate in the treatment of ununited femoral shaft fractures. J Trauma. 2004; 57(4):832-6. DOI: 10.1097/01.ta.0000092684.67107.ee. View

13.

Matsuda Y, Sakayama K, Okumura H, Kawatani Y, Mashima N, Shibata T . Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nihon Geka Hokan. 1999; 67(1):10-7. View

14.

Zhang Q, Zhang W, Zhang Z, Zhang L, Chen H, Hao M . Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res. 2017; 12(1):183. PMC: 5702156. DOI: 10.1186/s13018-017-0684-y. View

15.

Malhotra A, Pelletier M, Yu Y, Walsh W . Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes. Arch Orthop Trauma Surg. 2012; 133(2):153-65. DOI: 10.1007/s00402-012-1641-1. View

16.

Matelic T, Monroe M, Mast J . The use of endosteal substitution in the treatment of recalcitrant nonunions of the femur: report of seven cases. J Orthop Trauma. 1996; 10(1):1-6. DOI: 10.1097/00005131-199601000-00001. View

17.

Zimmermann G, Moghaddam A, Wagner C, Vock B, Wentzensen A . [Clinical experience with bone morphogenetic protein 7 (BMP 7) in nonunions of long bones]. Unfallchirurg. 2006; 109(7):528-37. DOI: 10.1007/s00113-006-1078-5. View

18.

Ru J, Niu Y, Cong Y, Kang W, Cang H, Zhao J . Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. Acta Orthop Traumatol Turc. 2015; 49(6):668-75. DOI: 10.3944/AOTT.2015.14.0404. View

19.

Shroeder J, Mosheiff R, Khoury A, Liebergall M, Weil Y . The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma. 2009; 23(9):653-7. DOI: 10.1097/BOT.0b013e3181a2a337. View

20.

Eom T, Kim J, Oh H, Kim J . Challenge to treat hypertrophic nonunion of the femoral shaft: the Poller screw augmentation technique. Eur J Orthop Surg Traumatol. 2016; 26(6):559-63. DOI: 10.1007/s00590-016-1814-7. View