Concomitant Intramedullary Nailing And Plate Augmentation As A Single-Stage Procedure In Treating Complicated Nonunited Femoral Shaft Fractures

Background and Purpose: Complicated femur fracture represents a major challenge for the orthopedic surgeon, with failed internal fixation, nonunion with broken intramedullary nail (IMN), and infected nonunion among the complications. Mechanical instability, as well as the poor biological environment, is considered as a concern when treating these cases. The purpose of this study was to evaluate concomitant IMN and plate augmentation as a single-stage procedure for the management of multiply operated nonunited femoral shaft fractures.Materials and Methods: Between January 2015 and May 2018, nine patients (eight men) with an average age of 40.8 years (range 25-70) diagnosed as nonunion femoral fractures after an average of four previous surgeries (range 2-6). All patients were available for follow-up with an average of 22 months (range 12-36).Results: The average time for fracture union was 6.7 months (range 3-12); five patients needed bone grafting to compensate for the bone defect encountered during the initial procedure, and two patients required secondary bone grafting after 6 months follow-up. Two patients presented with surgical site infection which was treated by antibiotics and daily dressing. The average leg length discrepancy at last follow-up was 1 cm (range 0.5-1.5). No patient had a metalwork failure or needed removal of the implants.Conclusion: In treating complicated multiply operated nonunited femoral shaft fractures, we believe that this technique can provide a robust mechanical foundation as well as an improved biological environment for such nonunited fractures to heal.