Intramedullary ­nail ­rescue­ with ­plate­ stabilization

Article Sidebar

PDF (Español (España))
Published: Aug 27, 2014
DOI: https://doi.org/10.15417/305
Keywords:
Nonunion. Femur. Plate. Intramedullary nail.

Main Article Content

Pablo A. Bruno
Damián G. Bustos
Ignacio Fernandez Savoy
Natalia Gutierrez Olivera
Bartolome L. Allende
Eliseo J. Firman
Santiago J. Svarzchtein
Pablo S. Sasaki
Alberto Cid Casteulani

Abstract

Background: Femoral nonunion is a rare complication after intramedullary nailing. There is controversy about the best treatment option. In specific cases, femoral nonunions can be successfully treated by stabilization with plates over an intramedullary nail.Methods: Retrospective review of 16 femur nonunions previously treated with intramedullary nails (12 atrophic, 4 hypertrophic). Lateral approach was used for plate fixation. Previous intramedullary nail was maintained in all cases. Twelve patients underwent osteoperiosteal decortication and autologous bone graft; in 3 of them platelet growth factors were added. In 4 hypertrophic nonunions, no bone graft was added to plate osteosynthesis.Results: ­Average healing time was 5.3 months after plate fixation. No additional surgeries were needed. One patient suffered a superficial wound infection successfully treated with oral antibiotics.Conclusions: Exchange of intramedullary nail is the method of choice for most aseptic nonunions of femoral diaphysis, but this technique is more demanding in metaphyseal nonunions, in atrophic nonunions with bone defects, and when the biggest intramedullary nail is already in place. Plate provides compression and stability to the fractures, being a good alternative to treat this complication. Minimal debridement of soft tissue and decortication limited to the nonunion is recommended. 

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Article Details

How to Cite
Bruno, P. A., Bustos, D. G., Fernandez Savoy, I., Gutierrez Olivera, N., Allende, B. L., Firman, E. J., Svarzchtein, S. J., Sasaki, P. S., & Cid Casteulani, A. (2014). Intramedullary ­nail ­rescue­ with ­plate­ stabilization. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 79(3), 163-168. https://doi.org/10.15417/305
Issue
Vol 79 No 3 (2014)
Section
Clinical Research
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Manuscript acceptance by the Journal implies the simultaneous non-submission to any other journal or publishing house. The RAAOT is under the Licencia Creative Commnos Atribución-NoComercial-Compartir Obras Derivadas Igual 4.0 Internacional (CC-BY-NC.SA 4.0) (http://creativecommons.org/licences/by-nc-sa/4.0/deed.es). Articles can be shared, copied, distributed, modified, altered, transformed into a derivative work, executed and publicly communicated, provided a) the authors and the original publication (Journal, Publisher and URL) are mentioned, b) they are not used for commercial purposes, c) the same terms of the license are maintained.

In the event that the manuscript is approved for its next publication, the authors retain the copyright and will assign to the journal the rights of publication, edition, reproduction, distribution, exhibition and communication at a national and international level in the different databases. data, repositories and portals.

It is hereby stated that the mentioned manuscript has not been published and that it is not being printed in any other national or foreign journal.

The authors hereby accept the necessary modifications, suggested by the reviewers, in order to adapt the manuscript to the style and publication rules of this Journal.

References

1. Hakeos WM, Richards J, Obremskey WT. Plate fixation of femoral nonunions over an intramedullary nail with autogenous
bone grafting. J Orthop Trauma 2011;25(2):84-9.

2. Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and
twenty cases. J Bone Joint Surg Am 1984;66:529-39.

3. Kempf I, Grosse A, Beck G. Closed locked intramedullary nailing. Its application to comminuted fractures of the femur. J Bone
Joint Surg Am 1985;67:709-20.

4. Brinker MR, O’Conner DP. Exchange nailing of ununited fractures. J Bone Joint Surg Am 2007;89:177-88.

5. Garcia P, Pieruschka A, Klein M, Tami A, Histing T, Holstein JH, et al. Temporal and spatial vascularization patterns
of unions and nonunions: role of vascular endothelial growth factor and bone morphogenetic proteins. J Bone Joint Surg
2012;94:49-58.

6. Pihlajamaki HK, Salminen ST, Bostman OM. The treatment of nonunions following intramedullary nailing of femoral shaft
fractures. J Orthop Trauma 2002;16:394-402.

7. Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma
1997;43:263-7.

8. Danckwardt-Lilliestrom G. Reaming of the medullary cavity and its effect on diaphyseal bone. A fluorochromic,
microangiographic and histologic study on the rabbit tibia and dog femur. Acta Orthop Scand 1969;128:1-153.

9. Utvåg SE, Grundnes O, Reikerås O. Graded exchange reaming and nailing of non-unions. Strength and mineralisation in rat
femoral bone. Arch Orthop Trauma Surg 1998;118:1-6.

10. Weber BG, Brunner C. The treatment of nonunion without electrical stimulation. Clin Orthop 1981;161:24-32.

11. Nadkarni B, Srivastav S, Mittal V, Agarwal S. Use of locking compression plates for long bone nonunions without removing
existing intramedullary nail: review of literature and our experience. J Trauma 2008;65:482-6.

12. Finkemeier CG, Chapman MW. Treatment of femoral diaphyseal nonunions. Clin Orthop Relat Res 2002;398:223-34.

13. Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ. Failure of exchange reamed intramedullary nails for
united femoral shaft fractures. J Orthop Trauma 2000;14:335-8.

14. Ueng SW, Chao EK, Lee SS, Shih CH. Augmentative plate fixation for the management of femoral nonunion after
intramedullary nailing. J Trauma 1997;43:640-4.

15. Choi YS, Kim KS. Plate augmentation leaving the nail in situ and bone grafting for non-union of femoral shaft fractures.
Int Orthop 2005;29:287-90.

16. Park K, Kim K, Choi YS. Comparison of mechanical rigidity between plate augmentation leaving the nail in situ and
interlocking nail using cadaveric fracture model of the femur. Int Orthop 2011;35(4):581-5.

Most read articles by the same author(s)

1 2 > >>