Clinical Study Of Augmentative Plate Fixation Combined With One Side Bone Graft For The Treatment Of Femoral Hypertrophic Nonunion Subsequent To Intramedullary Nailing Fixtion

Objective:To investigate the necessity of bone graft and the effect of augmentative plate fixation combined with one side bone graft for the treatment of femoral hypertrophic nonunion subsequent to intramedullary nailing fixtion.Methods:23 cases with femoral hypertrophic nonunions after intramedullary nail internal fixation were treated with augmentative plate fixation from July 2007 to July 2012,lost 3cases,20 cases were selected,included 12 males and 8 females with a mean age of 41.6years(ranged from 28 to 54 years). The mean period of nonunions after surgery was 17.5months(ranged from 9 to 28 months). All patients applied with augmentative plate,retained the original intramedullary nail,and combined with one side auto-ilial bone graft. 7 days after the operation,patients were allowed to partial weight-bearing until full weight-bearing in 6 months after operation.All patients were fullowed up and were evaluated with clinical and imaging results in 1,3,6,12 months after operation.Results:All patients were fullowed up from 12-48 months,averaged 33.3 months.20 patients achieved clinical bone union an average 12.4 months(ranged 9 to 16 months).Of them,donor site pain of iliacoccurrenced on 5 cases,symptoms resolved within 1 months,no infection, internal fixation loosening,breaking and other complications. Obvious callus wasobserved at the broken ends of fracture 7 months after the operation,bone graft side callus time averaged 7 months,no bone graft side callus time averaged 7.8 months.Both side callus time no significant difference(Z=-1.302,P=0.193>0.05).Conclusions:Augmentative plate fixation for the treatment of femoral hypertrophic nonunion subsequent to intramedullary nailing fixtion without bone graft has statisfied clinical efficacy,and the advantages of simple,small injury,less complication.This technique is one of the effective treatment method for the intramedullary nail fixation of hypertrophic nonunion.