Aseptic nonunion of a femoral shaft treated using exchange nailing

There are many methods for treating femoral shaft aseptic nonunions of which exchange nailing is the simplest technique. However, the reported success rate varies. Therefore, a prospective study was conducted to further clarify the role of exchange nailing.

From October 1994 through December 1999, 40 femoral shaft aseptic nonunions in 39 patients were treated using exchange nailing. The indications for this technique included a femoral shaft aseptic nonunion with a previously inserted intramedullary nail, less than 1 cm shortening, a radiolucent line of the nonunion, and no segmental bony defects. The surgical technique consisted of close removal of the previously inserted intramedullary nail, reaming the intramedullary canal as widely as possible (1 or 2 mm oversized), and re-insertion of a stable unlocked or locked intramedullary nail.

Thirty-six femoral shaft aseptic nonunions in 35 patients were followed-up for at least 1 year (median, 2.9 years; range, 1.1-6.0 years) and 33 nonunions healed. The union rate was 91.7% (33/36) and the union period was median 4 months (range, 3-8 months). No major surgical complications were noted. The other three patients with persistent nonunions were continuously followed-up due to their reluctance for further operations.

Although exchange nailing is a relatively simple surgical technique, it can still achieve a high union rate with a low complication rate. Despite that factors to induce a persistent nonunion are still unclear, clinically, exchange nailing should be used as the first choice in the treatment of an indicated femoral shaft aseptic nonunion.