Management of aseptic femoral shaft nonunion after intramedullary nailing by augmented plate fixation

Background: Nonunion of femoral shaft fractures after intramedullary nailing could cause physical and psychological impact on the patients. Plate augmentation has been used to provide additional stability, and bone graft is added to stimulate the healing. The purpose of this study was to evaluate the results of using the technique of plate augmentation over the retained nail with bone graft in the management of aseptic femoral shaft nonunion. Patients and methods: A retrospective study was conducted from 2017 to 2022. The outcome measures, including operative time, blood loss, radiological healing by the modified radiological union scale for tibia (mRUST) score, and limb function by Wu’s scoring system, were analyzed. Results: 23 patients (17 males, 6 females) with a mean age of 35 ±8.2 years were followed up for 28.6 ±9 months. The mean operative time was 71.3 ±15.2 minutes. The mean operative blood loss was 258.7 ±43.1 ml. All nonunions healed after a mean duration of 5.2 ±0.8 months without complications recorded. The mean mRUST score was 12.45 ±1.15. The mean preoperative Wu’s score was 14.6 ±11.2 which improved to 45.8 ±2.3 at the last follow-up with a statistically significant difference (P=0.014). Conclusion: Augmentation plate over retained nail technique used for aseptic femoral shaft nonunion in our study provides sufficient mechanical stability and stimulates healing throughout bone grafting with limited surgery. This technique is simple and effective to achieve higher union rates with fewer complications. It could save time, as there is no need for nail removal and its challenges.