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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
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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: doconnor2@uh.edu).

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.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal's Web site (www.jorthotrauma.com).

Accepted June 06, 2014

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