Augmentative compression plating versus exchanging reamed nailing for nonunion of femoral shaft fracture after intramedullary nailing : A retrospective cohort study

Aim of the present study was to compare the outcomes between exchanging reamed nailing (ERN) and augmentative compression plating (ACP) in treatment of femoral shaft nonunion after intramedullary nailing (IMN) retrospectively. A retrospective, multicentre study was performed with 188 patients (190 cases)with femoral shaft nonunion after IMN, who received therapy with either ERN (n = 92) for 44/92 (47.8%) cases of nonisthmal nonunions and 48/92 (52.2%) cases of isthmal non unions or ACP (n = 98) for 48/98 (49%) cases of nonisthmal nonunions and 50/98 (51%) cases of isthmal nonunions. Operation time, intraoperative blood loss, time to union, union rate, postoperative draining volume and complication rate were compared between ERN and ACP group. After a mean follow-up of 4.6 years (range 1-8.1 years), the bone union occurred in 98/98 (100%) cases in total ACP group versus 80/92 (87%) cases in total ERN group [odds ratio (OR) = 3.34, 95% confidence interval (CI) 0.8-1.6]. Twelve cases with re-nonunion in the total ERN group included 10/12 (833%) cases of nonisthmal nonunions and 2/12 (16.7%) cases of isthmal nonunion with cortical bone defect > 3 cm. The average time to union, the intraoperative blood loss and the complication rate in total ERN group were also both significantly more than that in total ACP group (p = 0.031, p = 0.042, p = 0.028). No significant difference was found in the average operation time between the two total groups (p = 0.213). However, for nonisthmal nonunions, the mean operation time for ERN group was 126.8 +/- 19.6 min in comparison to ACP group (88.6 +/- 15.2 min), significant difference was found between ERN group and ACP group (p = 0.021). ACP could obtain the higher bone union rate and shorter time to union than ERN in the treatment nonunions with larger bone defect, ACP could bring more advantages to patients than ERN. A prospective observational study is needed.of femoral shaft nonunion after failed IMN. Especially for nonisthmal femoral shaft nonunions or isthmal