Outcome of interlocking nailing with autogenous cancellous bone graft in Nonunion of femoral shaft fractures

Background: The femoral shaft, a key weight-bearing bone, is prone to fractures from high-energy trauma, comprising up to 4% of all fractures. Intramedullary nailing is the standard treatment due to its stability and minimally invasive nature, yet nonunion remains a significant complication, occurring in 1-11% of cases. Nonunion causes prolonged disability and necessitate complex, costly treatments. Its multifactorial etiology includes poor stabilization, biological deficits, and systemic factors. While interlocking nailing provides mechanical support, biologically inactive nonunions often require autogenous bone grafting. Harvested from the iliac crest, such grafts enhance healing. Combined approaches have shown union rates exceeding 90% in multiple studies. Aim of the study: This study aims to evaluate the clinical and radiological outcomes of interlocking nailing augmented with autogenous cancellous bone graft in patients with nonunion of femoral shaft fractures. Methods: This retrospective observational study was conducted at Department of Ortho-Surgery, Rangpur Medical College Hospital, Rangpur, Bangladesh from January to December 2023, involving 30 patients with radiologically confirmed femoral shaft nonunion. Eligible adults underwent interlocking intramedullary nailing with autogenous cancellous bone grafting from the iliac crest. Standard preoperative assessments were done, and surgeries were performed under spinal anesthesia. Postoperative care included antibiotics, physiotherapy, and staged weight-bearing. Patients were followed up at 1, 3, 6, and 12 months with clinical and radiological evaluations. Union was defined radiographically and clinically, and functional outcomes were measured using the Harris Hip Score. Data were analyzed using SPSS v26.0. Results: Among 30 patients treated for femoral shaft nonunion, 80% were male, and 50% were aged 30-50. Smoking was reported in 60%, and 36.7% had comorbidities. The average nonunion duration was 11.6±4.2 months, with 63.3% involving the midshaft. Radiological union was achieved in 90% of cases, averaging 7.8±2.5 months. Functional outcomes were favorable, with a mean Harris Hip Score of 82.6±9.3. Outcomes were excellent in 33.3%, good in 40%, fair in 16.7%, and poor in 10%. Complications were minimal, including superficial infection (6.7%), deep infection (3.3%), and reoperation in two cases (6.7%). Conclusion: Interlocking intramedullary nailing with autogenous cancellous bone grafting is a safe, effective treatment for femoral shaft nonunion, achieving a 90% union rate and good functional outcomes. This approach is especially suitable for resource-limited settings like Bangladesh, offering reliable healing and limb function restoration with low complication rates.