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

Article information

J Musculoskelet Trauma. 2019;32(2):83-88

Publication date (electronic) : 2019 April 10

doi : https://doi.org/10.12671/jkfs.2019.32.2.83

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., 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 E-mail: leekci@chosun.ac.kr

Received 2018 March 21; Revised 2018 August 30; Accepted 2018 December 28.

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

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.

Table 1.

Patients Demographic Data

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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.

Fig. 1.

Fig. 2.

Table 1.

Patients Demographic Data

Case No.	Age (yr)	Sex	Combined injury	Location of fracture W	Winquist−Hans classification	sen n Comorbidit	ty Smoking	gSoft tissue injury M to	onths injury o nonunion	Weeks exchange nail to union
1	32	M		Distal shaft	I		Y	Closed	9	18
2	46	F		Midshaft	II		Y	Closed	10	28
3	25	M	Acetabular Fx.	Midshaft	I		N	Closed	9	32
4	52	M		Proximal shaft	I		Y	Closed	20	32
5	27	M	Both tibia Fx.	Midshaft	I		N	Open	15	36
6	58	M		Distal shaft	0	DM	N	Closed	9	32
7	62	M		Midshaft	I	HTN, DM	Y	Closed	22	Nonunion
8	24	M		Proximal shaft	III		N	Closed	10	16
9	37	M		Midshaft	I		N	Closed	9	32
10	45	M	Patella Fx.	Midshaft	0	HTN	N	Closed	12	32
11	44	M		Distal shaft	I		Y	Closed	10	Nonunion
12	37	M	Tibio-fibular Fx. Patella Fx.	Midshaft	II		N	Closed	9	44 (delayed union)
13	25	F		Midshaft	0		N	Closed	9	14
14	22	M		Distal shaft	I		N	Closed	10	30
15	25	M	Acetabular Fx.	Proximal shaft	I		N	Closed	12	28
16	56	M		Midshaft	III	HTN	Y	Closed	16	36
17	65	M	Tibia Fx.	Midshaft	I	DM	N	Open	9	36
18	62	F		Midshaft	II	HTN, DM	N	Closed	9	32
19	44	M		Proximal shaft	I		N	Closed	10	26
20	43	F		Distal shaft	0		Y	Closed	12	Nonunion
21	28	M		Midshaft	I		N	Closed	15	16
22	20	F		Midshaft	II		N	Closed	9	14
23	33	M		Midshaft	I		N	Closed	9	16
24	27	M		Distal shaft	I		N	Closed	9	28
25	25	M	Patella Fx.	Midshaft	III		N	Closed	12	24
26	29	F		Midshaft	0		N	Closed	24	28
27	32	F		Distal shaft	I		N	Closed	12	28
28	42	F		Midshaft	I		Y	Closed	20	24
29	56	M	Acetabular Fx.	Midshaft	II	HTN	N	Closed	9	36
30	25	M		Distal shaft	I		N	Closed	12	28
31	48	M		Midshaft	0		Y	Closed	16	36
32	39	F	Patella Fx.	Distal shaft	I		N	Closed	12	32
33	43	F		Distal shaft	II		Y	Open	9	Nonunion
34	28	M		Midshaft	I		N	Closed	9	16
35	24	M		Proximal shaft	I		N	Closed	12	28

M: male, F: female, Fx.: fracture, DM: diabetes mellitus, HTN: hypertension, Y: yes, N: no.