Augmentation plates and bone grafting for treatment of nonunited long bones fractures fixed by intramedullary nails

Background
A delayed union was defined as when the fracture fails to unite within the expected time. Delayed union becomes nonunion when the fracture healing stops (at least 6 months). Intramedullary nailing has proven to be a good treatment option in the management of long bones fracture. The aim of this study is to obtain union in nonunited long bones fractures fixed previously by intramedullary nails by using of augmentation plating and bone grafting to obtain the best outcome.
Patients and methods
The study included 18 patients of nonunited long bones fractures fixed previously by intramedullary nails treated with augmentation plating and bone grafting with maintaining the nail in situ. Full history, clinical and radiological examination were performed. All subjects gave their informed consent prior to their inclusion in the study. Eight cases with femoral fracture nonunion were performed through the lateral approach of the femur. Seven cases of tibial fracture nonunion were performed through the anterior approach of the tibia, Three cases of humeral nonunion was performed using the posterior approach of the humerus. In the postoperatively follow-up, function was assessed using Dash score and Lower extremity functional score.
Results
There was an excellent improvement for bone union occurred to 94.4% of studied patients. Furthermore lower extremities function percent ranged between 92.5-100 with mean±SD 98.1 ± 2.56, and humerus Dash score ranged between 4.16-6.66 with mean±SD 5.41 ± 1.77. There was statistically insignificant difference between the period of nonunion bone per months and fracture bone criteria of studied patients P>0.05. Also, there is statistically insignificant difference between lower extremities function score percent after implant procedure and fracture bone criteria of studied patients P > 0.05.
Conclusion
Augmentation plating is an excellent solution for the management of nonunited nailed long bones fractures with maintaining the nail in situ, especially with instability at nonunion site and comminution or gap nonunion.