Reunion of post nail aseptic non-union of diaphyseal femoral fractures by augmentation plating, decortication and bone grafting – Replacement for exchange nailing

Injury ◽  
2020 ◽  
Author(s):  
Krishna Kumar Mittal ◽  
Himanshu Gupta ◽  
Nitin Kaushik
Keyword(s):  
Bone Grafting ◽  
Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing ◽  
Augmentation Plating

scholarly journals Systematic review of dynamization vs exchange nailing for delayed/non-union femoral fractures

2018 ◽  
Vol 9 (7) ◽  
pp. 92-99 ◽  
Author(s):  
Jacob E Vaughn ◽  
Ronit V Shah ◽  
Tarek Samman ◽  
Jacob Stirton ◽  
Jiayong Liu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing

scholarly journals A case of subtrochanteric femur fracture nonunion with failed implant in situ treated with exchange nailing using interlock nail and autologous bone grafting: a case report

2021 ◽  
Vol 7 (4) ◽  
pp. 864
Author(s):  
Neetin P. Mahajan ◽  
Pranay Kondewar ◽  
Lalkar Gadod ◽  
Amey Sadar ◽  
Shubham Atal
Keyword(s):  
Clinical Outcome ◽  
Bone Grafting ◽  
Femur Fracture ◽  
Good Clinical Outcome ◽  
Non Union ◽  
Autologous Bone Grafting ◽  
Exchange Nailing ◽  
Autologous Bone ◽  
Subtrochanteric Femur Fracture

<p class="abstract">Subtrochanteric femur fracture accounts for 25% of all hip fracture and may land up in non-union due to the inadequate reduction and fixation tech, local muscle pull over fragments, biomechanical stress in subtrochanteric region and soft tissue interposition etc., non-union are managed with various choices of implants like exchange nailing , angle blade plate , dynamic condylar screw, augmentation of previous hardware with plate and by providing biological environments at fracture site using  bone graft. Strict adherence to principles of providing stability to fracture and providing environment for bony growth gives good clinical outcome. A 52 years old male with subtrochanteric femur fracture was operated with long PFN, later presented to us after 18 months with failure of the hardware and atrophic non-union manifesting as pain during walking and limping. Patient was operated with removal of implant and exchange nailing using femur interlock nail and autologous bone grafting from iliac crest graft. 1 year follow up showed complete bony union and abundant of callus formation. Patient is currently doing all the daily activities and have no complaints at present. At 1 year follow up there is complete union at non-union site and good clinical outcome is achieved. Exchange nailing with interlock nail and autologous bone grafting for treatment of atrophic non-union of subtrochanteric femur fractures gives good clinical outcome.</p>

scholarly journals Peri-implant fracture: a rare complication after intramedullary fixation of trochanteric femoral fracture

2021 ◽  
Author(s):  
Lauri M. Halonen ◽  
Antti Stenroos ◽  
Henri Vasara ◽  
Jussi Kosola
Keyword(s):  
Rare Complication ◽  
Treatment Strategies ◽  
Femoral Fractures ◽  
Delayed Union ◽  
Intramedullary Fixation ◽  
Fixation Method ◽  
Trochanteric Fractures ◽  
Non Union ◽  
Trochanteric Femoral Fracture ◽  
Exchange Nailing

Abstract Introduction Trochanteric femoral fractures are among the most common operatively treated fractures. Intramedullary fixation has become the treatment of choice in many centers around the world. Nevertheless, the knowledge of rare complications of these fractures is limited. In this study, the incidence and treatment strategies for peri-implant fractures (PIF) were assessed. Materials and methods A single-center retrospective cohort study was done on 987 consecutive operatively treated trochanteric fractures. PFNA cephalomedullary nail was used as a fixation method. All patients were followed up from patient records for peri-implant fractures. Plain radiographs as well as different salvage methods were analyzed and compared. Results The total rate of peri-implant fractures was 1.4% (n = 14). The rate of PIF for patients treated with short (200 mm) nails, intermediate-length (240 mm) nails, and long nails was 2.7% (n = 2), 1.5% (n = 11), and 0.7% (n = 1), respectively (ns, p > 0.05 for difference). Treatment of choice for PIF was either ORIF with locking plate (57%, n = 8) or exchange nailing (43%, n = 6). None of the PIF patients needed additional surgeries for non-union, malunion, or delayed union. Conclusions A PIF is a rare complication of intramedullary fixation of trochanteric fractures. It can be treated with either locking plates or exchange nailing with sufficient results. There are no grounds for favoring long nails to avoid PIFs.

scholarly journals Exchange Nailing as Revision Surgery for Post-operative Non-union of Atypical Femoral Fractures: A Case Report and Treatment Strategy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tomohiro Yasuda ◽  
Masayuki Arai ◽  
Daichi Shinohara ◽  
Yuki Samejima ◽  
Koji Kanzaki ◽  
...  
Keyword(s):  
Case Report ◽  
Revision Surgery ◽  
Femoral Fracture ◽  
Callus Formation ◽  
Femoral Fractures ◽  
Femoral Shaft ◽  
Medullary Canal ◽  
Atypical Femoral Fractures ◽  
Non Union ◽  
Exchange Nailing

Introduction: Atypical femoral fractures account for only 0.5% of femoral shaft fractures, but delayed union or non-union occurs in 50% of atypical femoral fractures accompanied by femoral lateral bowing. Such fractures are difficult to treat. Case Report: The case was an 84-year-old woman. She was diagnosed post-operative non-union of atypical femoral fracture. We planned a revision surgery for post-operative non-union of the atypical proximal femoral fracture. A two-dimensional template was used to simulate the intramedullary nail (IMN). Due to the advanced femoral lateral bowing deformity, a mismatch with the nail was noted when the unaffected femur was used to construct the template. When the opposite side nail was used as a template, the nail was aligned with the medullary canal, and the tip of the nail coincided with the center of the medullary canal; hence, the opposite side nail was chosen. Radiographical assessments of healing of the fracture confirmed callus formation and complete bone union 3 months and 1 year after the operation, respectively. Conclusion: We found that exchange nailing as revision surgery for post-operative non-union of atypical femoral fractures combined with an IMN on the opposite side was useful. Keywords: Alendronate, femoral fracture, osteoporosis, revision surgery.

scholarly journals Exchange nailing with Uni-cortical plate augmentation +/- bone grafting for proximal 2/3rd distal 1/3rd junction shaft non-union femur

2021 ◽  
Vol 7 (3) ◽  
pp. 404-407
Author(s):  
Dr. Anshul Sethi ◽  
Dr. Aditya Kumar Mishra ◽  
Dr. Mohd. Bilal Kaleem ◽  
Dr. Navneet Badoni ◽  
Dr. Amish Bhandari ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Cortical Plate ◽  
Non Union ◽  
Exchange Nailing

Integrated dual lag screws versus single lag screw cephalomedullary nail constructs: a meta-analysis and systematic review

2021 ◽  
pp. 112070002098506
Author(s):  
James R Onggo ◽  
Mithun Nambiar ◽  
Jason D Onggo ◽  
Anuruban Ambikaipalan ◽  
Parminder J Singh ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Meta Analysis ◽  
Femoral Fractures ◽  
Harris Hip Score ◽  
Complication Rates ◽  
Non Union ◽  
Lag Screw ◽  
Significant Difference ◽  
Lower Complication ◽  
Cephalomedullary Nails

Background/Aim: This study aims to determine the safety and efficacy of integrated dual lag screw (IDL) cephalomedullary nails (CMN) when compared with single lag screw (SL) constructs, in the internal fixation of intertrochanteric femoral fractures. Methods: The Smith & Nephew InterTan IDL was compared with SL CMN group consisting of the Stryker Gamma-3 (G3) and Synthes Proximal Femoral Nail Antirotation (PFNA) CMN. A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the clinical and radiological outcomes, complications and perioperative parameters of InterTan versus G3 or PFNA CMN in patients with intertrochanteric femoral fractures were extracted and analysed. Results: 15 studies were included in this meta-analysis, consisting of 2643 patients. InterTan was associated with lower complication rates in terms of all-cause revisions (OR 0.34; 95% CI, 0.22–0.51; p < 0.001), cut-outs (OR 0.30; 95% CI, 0.17–0.51; p < 0.001), medial or lateral screw migration (OR 0.19; 95% CI, 0.06–0.65; p = 0.008) as well as persistent hip and thigh pain (OR 0.65; 95% CI, 0.47–0.90; p = 0.008). In terms of perioperative parameters, InterTan is associated with longer operative times (MD 5.57 minutes; 95% CI, 0.37–10.78 minutes, p = 0.04) and fluoroscopy times (MD 38.89 seconds, 95% CI, 15.88–61.91 seconds; p < 0.001). There was no statistically significant difference in terms of clinical Harris Hip Score and radiological outcomes, non-union, haematoma, femoral fractures, varus collapse, length of stay and mean intraoperative blood loss between the 2 groups. Conclusions: Integrated dual lag screw cephalomedullary nails are associated with fewer revisions and complications. However, there is insufficient data to suggest that either nail construct is associated with better functional outcomes.

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