Indications and outcomes of augmentation plating with decortication and autogenous bone grafting for femoral shaft nonunions

Introduction: Though augmentation plating (AP) with decortication and bone grafting (BG) reportedly has excellent outcomes for femoral shaft nonunions, there are no established indications of AP with decortication and BG. The purpose of this study was to evaluate the results of AP with decortication and autogenous BG for femoral shaft nonunions, focussing on the indications of AP with decortication and BG. Methods: Thirty-nine patients treated with AP combined with decortication and BG for femoral shaft nonunions after femoral nail failure between November 1996 and October 2010 were retrospectively reviewed. Indications of AP with decortication and BG at the time of surgery and outcomes (bony union) were evaluated. Results: The mean follow-up duration was 24.8 months (range 12-81 months). Thirty-eight (97%) of 39 femoral shaft nonunions achieved bony union. One incompliant patient showed screw breakage, which was healed uneventfully with subsequent cast application. The mean time to union was 6.1 months (range 3-16 months). Primary indications at the time of surgery were nonisthmal femoral nonunions in 17 patients, isthmal nonunions in 10 patients (cortical bone defect in five and widened canal in five), failed exchange nail in seven patients, nonunions with malrotation in two patients and difficult removal in three patients. Conclusions: AP with decortication and autogenous BG is a good option for nonisthmal femoral shaft nonunions, such as supra-isthmal and infra-isthmal nonunions. In addition, this option is useful for selected cases of isthmal femoral shaft nonunions in which failure of exchange nailing is expected due to lack of a tight fit between the new larger nail and femoral cortices. (C) 2013 Elsevier Ltd. All rights reserved.