Treatment of Nonunion of Long Bones with Plate Augmentation with Retention of Intramedullary Nail - CASE SERIES

Introduction: Femoral and tibial fractures are common. Displaced fractures are best treated with intramedullary nailing (IMN), with excellent healing rates in most cases. However, as indications for nailing expand and trauma mechanisms tend to be more severe, nonunion cases are encountered. Many methods for treating these challenging cases were described including exchange nailing, conversion to plating and external fixation. The option of plate fixation retaining the previous nail osteosynthesis has been described lately. The purpose of this study was to describe our initial experience with this technique.

Patients and Methods: Between 2005-2017 7 patients with diaphyseal nonunions previously treated with IMNs were studied. These included 5 femoral and 2 tibiae. Mean time from index procedure to revision as 12 month (range 12-16) Surgical technique: an incision was made at the fracture site, previous locking bolts were moved in order to dynamize the nail and either a 4.5 or 3.5mm long locking plate (LCP, Synthes) was applied while the first two screws were inserted in compression mode followed by locking screws. Iliac crest bone graft (ICBG) was harvested and placed in the fracture site following debridement of all fibrous tissues. Immediate full weightbearing was prescribed. Patients were followed in the outpatient clinic

Results: All fractured healed, time for union was 7-12 weeks (mean 9 weeks). All patients reported painless weightbearing. No complications or reoperations were reported.

Discussion: Augmentation plating with bone grafting over retained nail shows promising result both in the tibia and femur. These are advantageous as there less extensive and allow immediate weight bearing while decreasing surgical rehab. In addition to minimizing time of surgery and complication.