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Results of a Systematic Approach to Exchange Nailing for the Treatment of Aseptic Femoral Nonunions

Swanson, Eli A. MD*,†; Garrard, Eli C. MD; Bernstein, Derek T. MD; O'Connor, Daniel P. PhD*,§; Brinker, Mark R. MD*,†

Journal of Orthopaedic Trauma: January 2015 - Volume 29 - Issue 1 - p 21–27
doi: 10.1097/BOT.0000000000000166
Original Article

Objectives: To evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail.

Design: Retrospective cohort.

Setting: Tertiary referral center.

Patients: Fifty aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ an average of 25 months after the initial fracture nailing were evaluated.

Intervention: Our systematic approach includes inserting an exchange nail at least 2 mm larger in diameter than the in situ nail, using a different manufacturer's nail, static interlocking, correction of any metabolic and endocrine abnormalities, and secondary nail dynamization in cases showing slow progression toward healing.

Main Outcomes Measurements: The outcome measures were radiographic and clinical evidence of nonunion healing and time to union.

Results: All 50 femoral nonunions (100%) healed after this systematic approach to exchange nailing. The average time to achieve union was 7 months (range, 3–26 months).

Conclusions: Utilization of this systematic approach of exchange nailing for the treatment of aseptic femoral nonunions resulted in a 100% healing rate.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

*Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX;

Department of Orthopaedic Trauma, The University of Texas Medical School at Houston, Houston, TX;

Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX; and

§Department of Health and Human Performance, University of Houston, Houston, TX.

Reprints: Daniel P. O'Connor, PhD, Department of Health and Human Performance, University of Houston, 3855 Holman GAR 104, Houston, TX 77204-6015 (e-mail:

D. P. O'Connor is a consultant for Nimbic, Inc. and receives research support from the Joe W. King Orthopedic Institute and royalties from SLACK, Inc. M. R. Brinker receives royalties from Lippincott Williams & Wilkins. The other authors report no conflict of interest.

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Accepted June 06, 2014

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