Reasons Of Femoral Shaft Nonunion After Intramedullary Nail Fixation And Surgical Treatment

Objective Retrospective analysis the reasons of femoral shaft nonunion after interlocking nailing. Review the results of different methods for different locations and different types of femoral shaft nonunion to provide reference for clinical treatment.Methods Check out femoral shaft fractures treated with interlocking intramedullary nail fixation from January 2005 to January 2012 and received 32 cases of which 23 males and9 females.Summarize the rist factors of nonunion and the cure rate of operation again. By one doctor pooled analysis and three chief surgeons confirmed respective risk factors for nonunion of 32 cases. Reoperative treatment healing rate use descriptive statistics for 30 cases of aseptic nonunion with different methods. The Gender composition, the mean of ages, the types(W-H classfication)of original fracture composition, the parts of the nonunion composition, the mean times of nonunion, the nonunion type(W-C classfication) composition and the reoperation healing rate of three major surgical operation by one surgeon were analyzed.Results Antegrade intramedullary fixation in 29 cases, retrograde intramedullary nailing in 3 cases, 2 patients complicated with diabetes, 2 patients with open fracture, 22 cases with open reduction and 10 closed reduction cases. Intramedullary nail is meticulous in 8cases, Wire cerclage bone in 4 cases, cross-section inaccurate 4 cases, Dynamic treatment(6 months to 2 years) in 4 cases and both hypertrophic nonunion, 2 cases of postoperative infection. Reoperation for internal fixation methods are varied. Treatment of infected nonunion with external fixator in 2 cases and using an integrated approach to control infection. All the 30 cases of aseptic femoral shaft nonunion combined with autogenous iliac Crest bone graft. It is no significant difference(P>0.05) at the mean of ages, the types(W-H classfication)of original fracture composition, the parts of the nonunion composition, the mean times of nonunion and the nonunion types(W-C classfication)composition. The healing rate of augmentation plating with a nail left and locking plate in the treatment of femoral shaft nonunion than replacement of intramedullary nail have obvious advantages in aspect of non-isthmus(P<0.05). It is no significant difference in healing rate between augmentation plating with a nail left and locking plate in the treatment of femoral shaft nonunion(P>0.05).Conclusions The reasons of femoral shaft nonunion after intramedullary nailing fixation are complex, both individual underlying causes of backward ideas and poor operative technology lead to mechanical and biological environment destroyed are the main reasons. The surgical treatment options of femoral shaft nonunion shoud according to the site,the type of nonunion, doctor personal habits and the reasons of nonunion to develop individualized treatment modalities.