Augmentation Plating with Intramedullary Nailing for Aseptic Long Bone Non-union: A Prospective Observational Study...

Non-union of long bone fractures after intramedullary nailing (IMN) remains a demanding clinical challenge. Augmentation plating - applying a supplementary plate over the retained nail - offers superior rotational control without the morbidity of nail extraction. This prospective study evaluated clinical, radiological, and functional outcomes of this technique for aseptic femoral and tibial non-unions.

Thirty patients with aseptic diaphyseal non-union of the femur or tibia underwent augmentation plating with selective autologous bone grafting (April 2024-September 2025). Radiological healing was assessed by the modified Radiographic Union Score for Tibia (mRUST). Functional recovery was quantified by the lower extremity functional scale (LEFS) and Wu's criteria.

All 30 patients (17 femoral, 13 tibial) achieved radiological union, representing a 100% union rate. Mean time to union was 6.23 ± 0.82 months (range 5-8 months). Femoral non-unions healed significantly faster than tibial non-unions (5.88 vs. 6.69 months; P = 0.005). The mean mRUST score improved from 5.17 ± 0.79 preoperatively to 15.33 ± 0.84 at final follow-up (P < 0.001). Mean LEFS improved from 31.77 ± 3.39 to 76.60 ± 3.77 (P < 0.001). By Wu's criteria, 60% achieved excellent and 30% achieved good results; no patient had a poor outcome. The complication rate was 10%, comprising two superficial infections managed conservatively and one deep infection managed with debridement, antibiotics, and implant retention; fracture union was achieved in all three.

Augmentation plating with selective autologous bone grafting delivers 100% union rates with predictable healing timelines and near-normal functional recovery in aseptic femoral and tibial non-unions. The technique is mechanically sound, biologically preserving, and operatively efficient - making it a reliable first-choice revision strategy in this clinical setting.