Orthopedic Research

Copyright © Ahmed A Khalifa

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ISSN: 2576-8875 Mini Review

Augmentation Plating in Treating Non-Union Femur

Fracture After Intra-Medullary Nailing
Ahmed A Khalifa* FRCS (Tr & Ortho), MSc
Assistant lecturer orthopedic and traumatology, Qena faculty of medicine and its university hospital, South Valley university, Qena, Egypt
*Corresponding author: Ahmed A Khalifa, FRCS (Tr & Ortho), MSc, Assistant lecturer orthopedic and traumatology, Qena faculty of medicine and its
university hospital, South Valley university, Qena, Egypt, Email:
Submission: January 30, 2019; Published: February 06, 2019

Abstract

Although intra-medullary nailing in treating femur fractures had been recognized as the gold standard line of management, it carries the risk of
non-union reaching up to 3%, many techniques had been described for management femur fracture non-union after nailing such as exchange nailing,
exchange plating and plate augmentation leaving the nail in situ, the aim of this review is to discuss the option of augmentation plating.

Introduction
primarily treated with IMN, they reported 100% fracture union at a
Intra-medullary nails (IMN) is considered as the gold standard
mean time of 7 months without complications, and concluded that
technique for treating long-bone fractures especially femoral di-
plate augmentation provided mechanical stability which resulted
aphysis fractures4, since its initial introduction in the 1970s [1,2].
in fracture union.
The use of IMN in communicated fractures is beneficial, with great-
er mechanical stability and reduction of internal bending, also less
surgical damage which reduces risk of infection compared to plate
fixation [3]. However, IMN has some disadvantages including ream-
ing trauma, technical difficulties, broken nails and the fracture bone
non-union [4].

The non-union rate of fracture union following IMN ranges from

0.5 to 3%; the most common type of the non-union is the hypertro-
phic type [5,6]. Many factors can contribute to failure of bone union
after IMN, Johnson et al. [7] proposed that the remaining rotational
instability after nailing which may reach up to 10°-15° rotational
movement, considered to be the main factor resulting in fracture
non-union. Many secondary treatment strategies were developed
for fracture non-union after IMN fixation, including: reamed and
exchange nailing, exchange plating, nail dynamization and augmen-
tation plating [8,9]. Figure 1:
A. Non-union fracture femur after IMN;
Why to augmentation plating is preferred? B. Follow up x-ray after 7 months of treatment with
augmentation plate.
Weresh et al. [10] suggested the re-evaluation of routine ex-
change nailing which was considered as the gold standard tech-
nique to treat non-union after femur fracture nailing, as union Since this initial description by Heng et al. [9] many surgeons
obtained in only 53% of the patients received exchange nailing in adopted this technique and there have been several reports con-
their series, with a significant number of patients required addi- firming the high efficacy of plate augmentation in the management
tional procedures to achieve fracture healing. Heng et al. [9] in 1997 of femur diaphyseal aseptic non-unions [11]. Comparing exchange
recognised that residual instability in diaphyseal femur fracture reamed nailing with augmentation plating in treating femoral frac-
treated with IMN is the leading cause for non-union, so they got ture non-union after nailing, Park et al. [12] in their series failed
the idea to apply an “augmentative” plate (Figure 1) keeping the to achieve union in 5 patients (72% failure) with exchange nailing,
nail in situ in a series of 17 non-united femoral fractures that were however 11 patients (100% success) treated with augmentation

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 Ortho Res Online J Copyright © Ahmed A Khalifa

plating achieved bony union, they suggested that augmentation contributes by its load-sharing capacity with good axial and bend-
plating with the add of autogenous bone grafting is a better option ing strength could perfectly result in fracture healing with better
than exchange nailing alone in dealing with femur fracture non- functional outcomes and faster patients’ recovery.
union after nailing.
References
Somford et al. [13] in their review has summarised current
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quires less skin incision and does not require removal of the nail femoral shaft nonunions with im nail exchange versus augmentation
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ability of bone grafting; rare complications; and a simpler shorter Strategies in Trauma and Limb Reconstruction 8(2): 77-88.
operation time with less bleeding compared with other techniques. 14. Chen CM, Su YP, Hung SH, Lin CL, Chiu FY (2010) Dynamic compression
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Volume - 5 Issue - 1
How to cite this article: Ahmed A K. Augmentation Plating in Treating Non-Union Femur Fracture After Intra-Medullary Nailing.Ortho Res Online J. 5(1). 2/3
OPROJ.000605.2019. DOI: 10.31031/OPROJ.2019.05.000605
 Ortho Res Online J Copyright © Ahmed A Khalifa

19. Choi Y, Kim K (2005) Plate augmentation leaving the nail in situ and plating leaving the inserted nail in situ in the treatment of aseptic tibial
bone grafting for non-union of femoral shaft fractures. International non-union: a two-centre study. Wiener klinische Wochenschrift 125(9-
Orthopaedics 29(5): 287-290. 10): 244-253.
20. Ateschrang A, Karavalakis G, Gonser C, Liener U, Freude T, et al. (2013)
Exchange reamed nailing compared to augmentation compression

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Volume - 5 Issue - 1
How to cite this article: Ahmed A K. Augmentation Plating in Treating Non-Union Femur Fracture After Intra-Medullary Nailing.Ortho Res Online J. 5(1). 3/3
OPROJ.000604.2019. DOI: 10.31031/OPROJ.2019.05.000605