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J Orthop Trauma. 2015 Jan;29(1):21-7. doi: 10.1097/BOT.0000000000000166.

Results of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions.

Author information

1
*Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX; †Department of Orthopaedic Trauma, The University of Texas Medical School at Houston, Houston, TX; ‡Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX; and §Department of Health and Human Performance, University of Houston, Houston, TX.

Abstract

OBJECTIVES:

To evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail.

DESIGN:

Retrospective cohort.

SETTING:

Tertiary referral center.

PATIENTS:

Fifty aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ an average of 25 months after the initial fracture nailing were evaluated.

INTERVENTION:

Our systematic approach includes inserting an exchange nail at least 2 mm larger in diameter than the in situ nail, 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.

MAIN OUTCOMES MEASUREMENTS:

The outcome measures were radiographic and clinical evidence of nonunion healing and time to union.

RESULTS:

All 50 femoral nonunions (100%) healed after this systematic approach to exchange nailing. The average time to achieve union was 7 months (range, 3-26 months).

CONCLUSIONS:

Utilization of this systematic approach of exchange nailing for the treatment of aseptic femoral nonunions resulted in a 100% healing rate.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

PMID:
24978947
DOI:
10.1097/BOT.0000000000000166
[Indexed for MEDLINE]
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