Treatment of aseptic femoral nonunions with exchange nailing resulted in a 100% healing rate, according to study results.
Researchers evaluated 50 aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ at an average of 25 months after the initial fracture nailing. Using a different manufacturer’s nail, static interlocking, correction of any metabolic and endocrine abnormalities and secondary nail dynamization in cases showing slow progression toward healing, the researchers inserted an exchange nail in patients that was at least 2 mm larger in diameter than the in situ nail. Outcome measures included radiographic and clinical evidence of nonunion healing and time to union.
At an average of 7 months after exchange nailing, all 50 femoral nonunions achieved bony union, according to study results. The researchers found 28% of nonunions had undergone nail dynamization performed between 3 and 9 months after exchange nailing due to concerns of slow progression to healing on radiographs.
At presentation with the nonunion, the diameters of the in situ nails ranged from 9 mm to 15 mm, which increased to a range from 11 mm to 21 mm after exchange nailing. Results showed time to bony union did not vary by patient age, gender, fracture pattern, soft tissues at the time of original injury, nonunion location, nonunion type, nonunion duration, history of prior failed dynamization of the in situ at presentation or increase in nail diameter with exchange nailing. – by Casey Tingle
Disclosure: Swanson has no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.