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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe optimal treatment for femoral shaft nonunion after intramedullary nail fixation is controversial and is a challenge for orthopaedic surgeons. This article discusses a retrospective study comparing nail exchange with augmentation plating to treat femoral shaft nonunion after nail fixation.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHip \u0026amp; Knee Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe optimal treatment for femoral shaft nonunion after intramedullary nail fixation is controversial and is a challenge for orthopaedic surgeons. Bosong Zhang, MD, Jishuitan Hospital, Beijing, China, described a retrospective study comparing nail exchange with augmentation plating to treat femoral shaft nonunion after nail fixation.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe nonunion rate for femur shaft fracture after nailing is as high as 12.5% [Pihlajam\u00e4ki HK et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2002]. Strategies for the treatment of femur shaft nonunion are bone grafting, exchange nailing, nail removal plus plating and bone grafting, leaving the nail in situ plus external fixation, and nail retention plus augmentation plating and bone grafting. In the literature, the union rate for exchange nailing ranges from 72% to 100% [Brinker MR, O\u0027Connor DP. \u003Cem\u003EJ Bone Joint Surg Am.\u003C\/em\u003E 2007], compared with almost 100% for augmentation plating and bone grafting [Park J et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2010; Choi YS et al. \u003Cem\u003EInt Orthop.\u003C\/em\u003E 2005].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe results of augmentation plating were compared with exchange nailing for femoral shaft nonunion after nailing in 104 cases. From March 2003 to June 2011, exchange nailing without autogenous bone grafting was performed in 21 patients, and augmentation plating with nail retention and autogenous bone grafting was performed in 83.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EExchange nailing was performed by nail removal, followed by use of a reamer to enlarge the femoral canal and insertion of a larger-diameter nail to enhance fixation stability. Prof Zhang noted that rotational instability is one reason for nonunion of femoral shaft fracture after interlocking nailing [Park J et al. \u003Cem\u003EJ Orthop Trauma.\u003C\/em\u003E 2010; Zhao G et al. \u003Cem\u003EChinese J Surg.\u003C\/em\u003E 2009; Ueng SW et al. \u003Cem\u003EJ Trauma.\u003C\/em\u003E 1997]. Augmentation plating combined with leaving the nail in situ in this instance can resolve the rotational instability and allow fracture healing [Choi YS et al. \u003Cem\u003EInt Orthop.\u003C\/em\u003E 2005; Wu CC et al. \u003Cem\u003EInt Orthop.\u003C\/em\u003E 2002]. The augmentation plate procedure in this study used a nonrotating plate and insertion of 3 screws on each side of the fracture. Screws were placed bicortically; the locking screw was placed monocortically. Simultaneous bone grafting was performed in patients who received an augmentation plate.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThere were no significant differences between the 2 groups in age, sex, volume of postoperative drainage, and length of hospital stay. For patients who underwent augmentation plating and bone grafting, operation time was significantly shorter, and volume of both intraoperative blood loss and autogenous blood reinfused was significantly less. In addition, this group had a significantly lower cost of hospitalization and a significantly shorter time to radiographic union than patients who underwent exchange nailing. The union rate with augmentation plating was 100%.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProf Zhang enumerated key differences between exchange nailing and augmentation plating via an antirotating plate. Augmentation plating is indicated for treatment of fracture nonunion anywhere along the length of the femur, whereas exchange nailing is indicated for the proximal two-thirds of the femur. Exchange nailing is contraindicated with bone loss and when no larger nail is available, and it requires use of a C-arm for intraoperative imaging. Use of augmentation plating requires bone grafting, but as shown in this study, augmentation plating has a shorter fracture union time and is associated with less operative blood loss. In addition, the cost tends to be lower with augmentation plating.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EProf Zhang concluded that for femoral shaft nonunion, use of an antirotating plate, leaving the nail in situ, with autogenous bone grafting may be a better option than exchange nailing.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/41\/11.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzol3p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}