DOI: 10.47582/jompac.1990210 ISSN: 2717-7505

Clinical outcomes of augmentation plating without nail exchange in aseptic femoral shaft nonunion

Hasan Basri Pınar
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Aims: Femoral shaft fractures (FSFs) are commonly treated with intramedullary nailing (IMN), the current gold standard. Although nonunion after IMN is uncommon, it remains a challenging complication. This study evaluated the outcomes of augmentation plating (AP) with autologous iliac crest bone grafting (AICBG) without nail exchange for aseptic femoral shaft nonunion following IMN.Methods: This retrospective study included 24 patients treated for aseptic femoral shaft nonunion after IMN between 2024 and 2026. Nonunion was defined as the absence of radiographic healing 6 months after the index procedure. Patients with infection, implant failure, bilateral fractures, or bone defects >3 cm were excluded. All patients underwent AP using a 4.5-mm dynamic compression plate combined with AICBG without nail exchange and were followed for at least 12 months. Results: The median age was 44.5 (37.0-54.5) years, and 20 patients (83.3%) were male. Motor vehicle accidents were the most common injury mechanism, and 12 patients had open fractures. Nonunion was located in the distal third in six patients and in the middle or proximal third in 18. Seven patients had atrophic nonunion, whereas 17 had oligotrophic or hypertrophic nonunion. Previous interventions included dynamization (n=4) and nail exchange (n=2). Radiographic solid union was achieved in all patients at a median of 5.0 (4.0-7.5) months. Median operative time was 60.0 (50.0-60.0) minutes. No major complications or implant failures occurred during a median follow-up of 14.0 (12.0-16.0) months. Conclusion: AP combined with AICBG while retaining the intramedullary nail was associated with radiographic union in all patients in this series and may represent a useful treatment option for selected patients with aseptic femoral shaft nonunion following IMN.

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