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Original Article Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing
Suenghwan Jo, Gwang Chul Lee, Sang Hong Lee, Jun Young Lee, Dong Hwi Kim, Sung Hae Park, Young Min Cho
Journal of Musculoskeletal Trauma 2019;32(2):83-88.
DOI: https://doi.org/10.12671/jkfs.2019.32.2.83
Published online: April 30, 2019
Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea. leekci@chosun.ac.kr

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Abstract

PURPOSE
This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes.
MATERIALS AND METHODS
From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results.
RESULTS
Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14–44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease.
CONCLUSION
Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.


J Korean Fract Soc. 2019 Apr;32(2):83-88. Korean.
Published online Apr 16, 2019.
https://doi.org/10.12671/jkfs.2019.32.2.83
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Original Article

Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing

Suenghwan Jo, M.D., Gwang Chul Lee, M.D., Sang Hong Lee, M.D., Jun Young Lee, M.D., Dong Hwi Kim, M.D., Sung Hae Park, M.D. and Young Min Cho, M.D.
    • Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Korea.
  • Correspondence to: Gwang Chul Lee, M.D. Department of Orthopaedic Surgery, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea. Tel: +82-62-220-3147, Fax: +82-62-226-3379, Email: leekci@chosun.ac.kr
Received March 21, 2018; Revised August 30, 2018; Accepted December 28, 2018.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study examined the outcomes of exchange nailing for the hypertrophic nonunion of femoral shaft fractures treated with intramedullary nailing as well as the factors affecting the treatment outcomes.

Materials and Methods

From January 1999 to March 2015, 35 patients, who had undergone intramedullary nailing with a femoral shaft fracture and underwent exchange nailing due to hypertrophic nonunion, were reviewed. This study investigated the time of union and complications, such as nonunion after exchange nailing, and analyzed the factors affecting the results.

Results

Bone union was achieved in 31 cases (88.6%) after exchange nailing and the average bone union period was 22 weeks (14–44 weeks). Complications included persistent nonunion in four cases, delayed union in one case, and superficial wound infection in one case. All four cases with nonunion were related to smoking, three of them were distal shaft fractures, and one was a midshaft fracture with underlying disease.

Conclusion

Exchange nailing produced satisfactory results as the treatment of hypertrophic nonunion after intramedullary nailing. Smoking is considered a factor for continuing nonunion even after exchange nailing. In the case of a distal shaft, where the intramedullary fixation is relatively weak, additional efforts are needed for stability.

Keywords
Femur, Nonunion, Exchange, Intramedullary nailing

Figures

Fig. 1
(A) Fracture site gap is shown after exchange nailing. (B) More deep insertion of the nail. (C) Distal screw fixation first, followed by pull out of the nail reversely. (D) Fracture site gap is reduced. (E) Proximal screw fixation finally.

Fig. 2
A 62-year-old male smoker. He had uncontrolled diabetes and blood pressure. (A) X-ray shows a left femur midshaft fracture (Winquist-Hansen Type I). (B) Initially, intramedullary nailing was done. (C) After 22 months, the X-ray shows hypertrophic nonunion. (D) Exchange nailing is done. (E) Finally, nonunion is presented.

Tables

Table 1
Patients Demographic Data

Notes

Financial support:This study was supported by research fund from Chosun University, 2014.

Conflict of interests:None.

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    Results of Exchange Nailing in Hypertrophic Nonunion of Femoral Shaft Fracture Treated with Nailing
    J Korean Fract Soc. 2019;32(2):83-88.   Published online April 30, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.2.83
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