Osman Çimen, Ali Öner, Alper Köksal, Ferdi Dırvar, Muhammed Mert, Deniz Kargın

Department of Orthopedics and Traumatology, Ministry of Health Metin Sabancı Baltalimanı Bone and Joint Diseases Training and Research Hospital, İstanbul, Türkiye

Keywords: Bone grafting, bone plates, exchange nailing, intramedullary nailing, femur, pseudoarthrosis.


Objectives: This study aims to evaluate the success of plate augmentation over a retained intramedullary nail (IMN) against exchange nailing performed with autologous bone grafting in oligotrophic and atrophic pseudoarthrosis of the femoral shaft.

Patients and methods: Between May 2005 and October 2020, a total of 42 of 56 patients (28 males, 14 females; mean age: 47.3±17.2 years; range, 19 to 84 years) with aseptic atrophic or oligotrophic femoral nonunion were retrospectively analyzed. The patients, 20 were operated with plate over a retained IMN, and the rest (n=22) by exchange nailing. Data including demographic and clinical characteristics of the patients, treatment success, duration of surgery, blood loss during surgery, infection rates, length of hospital stay, time to bridging of the nonunion site, and time to obliteration of the fracture line (solid union) were recorded.

Results: The mean follow-up was 23.8±20.4 (range, 12 to 96) months in the plate over an IMN group and 34.7±27.4 (range, 12 to 90) months in the exchange nailing group. At the final follow-up, solid union occurred in all of the patients in the plate augmentation over a retained IMN group, and 21 of 22 (95.45%) patients in the exchange nailing group. Blood loss during surgery was significantly less in the plate augmentation over IMN group (p=0.027). There was no statistically significant difference in the other variables between the two groups (p>0.05).

Conclusion: Our study results demonstrate that plate over a retained IMN is effective as exchange nailing in the surgical treatment of oligotrophic and atrophic pseudoarthrosis of the femoral shaft. However, it can be speculated that plate application over IMN is more advantageous in terms of blood loss during surgery.

Citation: Çimen O, Öner A, Köksal A, Dırvar F, Mert M, Kargın D. A comparison of exchange nailing and plate augmentation over a retained intramedullary nail in aseptic oligotrophic and atrophic femoral shaft pseudoarthrosis. Jt Dis Relat Surg 2023;34(1):121- 129. doi: 10.52312/jdrs.2023.788

Ethics Committee Approval

The study protocol was approved by the Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital Medical Specialty Education Board (date: 26.11.2020, no: 65/448). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Study design, writing the article: O.Ç.; Evaluating patients and last control: A.Ö.; Clinical evaluation of patients: A.K.; Collecting the data: F.D.; Radiological Measurement: M.M.; Study design and last control: D.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.