Plate augmentation leaving the nail in situ and bone grafting for the treatment of nonunited diaphyseal fractures

Background
Intramedullary nailing (IMN) is now the standard treatment for diaphyseal fractures. Despite recent advances in nailing techniques and designs, some cases of nonunion are still encountered. There are different lines of treatment for nonunion over IMN such as nail conversion to plate, exchange nailing, augmentation plating with bone grafting, and external fixation with nail retention. The aim of our study is to evaluate augmentation plating and bone grafting as a method of treatment for nonunited diaphyseal fractures over IMN.
Patients and methods
Eleven patients were included in this study. They were nine men and two women; their ages averaged 41 (18–54) years. The femur was affected in three cases, the tibia in six cases, and the humerus in two cases; all of them were treated by augmentation plating and bone graft.
Results
The follow-up duration averaged 14 (range: 9–24) months; union was achieved in all cases without complications of infection, implant failure, nonunion, or joint stiffness.
Conclusion
Augmentation plating and bone graft represents a good solution for the treatment of nonunited diaphyseal fractures over IMN