Plate augmentation after nailing for treatment of femoral shaft fracture nonunion

Background and aim There is too much debate about the treatment options for femoral shaft fractures that do not union after intramedullary nailing. The available methods in the literature range from nail dynamization, exchanging the nail with a larger one, and nail removal union following intramedullary nailing. This study aimed to evaluate the efficacy of plate augmentation and bone grafting without nail removal in the management of femoral shaft nonunion after intramedullary nail fixation. Patients and methods Our study included 20 patients with femoral shaft fracture nonunion after intramedullary nailing between October 2020 and March 2023, 15 males and five females. The mean age was 39.1±9.39 years. All patients were operated on by open reduction surgery and internal fixation by broad dynamic compression plate and bone graft with retention of the femoral nail. All patients were followed-up clinically and radiologically until complete bone healing (from 6 to 12 months). The perioperative range of motion was restored. Results Early and full weight-bearing started 2 weeks and 3 months after surgery, respectively. One case was complicated by wound infection and five cases were complicated by iliac graft morbidity. Time to solid union was 7.25±1.21 All cases returned to normal daily activities after 6 months. Conclusion Plate augmentation and bone grafting without removal of the femoral nail were valid and effective treatments for femoral shaft fractures that did not heal following intramedullary nailing.