Plate augmentation combined with bone grafting for aseptic non-union of femoral shaft fractures following interlocking nails.

TThe aim of this study was to evaluate plate augmentation over previously inserted interlocking nails, combined with iliac bone grafting in treating aseptic femoral shaft non-unions. The research was conducted prospectively on 34 patients. A narrow dynamic compression plate was placed while the nail was retained. All the screws were directed posterior to the nail. There were 25 males and 9 females with mean age of 36.6 years old. The mean operative time was 95 minutes with 320ml blood loss. 28 patients showed solid healing by 6 months postoperatively (82%). By 8 months, all patients showed solid union (mean 6.3 months). Full range was regained in both hips and knees and all patients could walk bearing full weight without supportive devices by 8 months. Where non-union occurs over an interlocking nail, augmenting it with a plate and bone grafting appears to be an effective treatment method to obtain solid union.

Augmentation plate without bone graft in the management of distal tibial diaphyseal non-union.

PURPOSE: The objective of this study was to assess the efficacy of augmentation plating with retaining of previous implant in situ in cases of non-united oligotrophic or atrophic aseptic distal tibial diaphyseal and metaphyseal fractures without bone grafting depending on the unified bone healing and non-union theory. METHODS: Through the period between December 2019 and December 2022, twelve patients with distal third tibial non-unions who were fixed at time of fracture either by intramedullary interlocking nails (seven cases) or by minimally invasive plate osteosynthesis (five cases) were included. Non-union was diagnosed on basis of absence of any healing progression in three months period or absence of fracture healing after six months from index surgery. All patients had oligotrophic or atrophic non-union. Augmentation plating through an anterolateral approach was done on average of 7.25 months after initial surgery (6-9 months). Circumferential exposure of the fracture site and debridement of fibrous tissue were not necessary. No bone grafting was done as no cases had major bone defect. RESULTS: All patients achieved complete radiological union with a mean time of 21.8 weeks (range 18-30 weeks) that mean full callus formation in all cortices. All patients were walking independently after three months (13weeks) from surgery and returned to work even in cases of absent complete radiological union. No cases had been complicated with wound healing problems (infection or dehiscence). One patient had incomplete ankle dorsiflexion (10°) due to tight calf muscles and one patient had paresthesia on the dorsum of the foot that was not improved at last follow up (one year after surgery). CONCLUSION: Augmentation plating is a safe and effective option for management of distal tibial diaphyseal nonunion even in cases of oligotrophic or atrophic non-union.