Evaluation of Outcome of Exchange Nailing with Autogenous Bone Graft for Treating Aseptic Nonunion of Femoral Shaft Fracture.

Femoral shaft fractures are severe injuries and challenging for both, the patient and the surgeon. This study has been designed to assess the success rate of exchange nailing with autogenous cancellous bone graft for the treatment of non united femoral shaft fractures previously treated by ORIF with intramedullary nail. This quasi experimental study was carried out in the Department of Orthopaedics & Traumatology of Dhaka Medical College Hospital and NITOR from July 2007 to December 2008. Thirteen patients were followed up regularly for at least 1 (one) year after each operation to assess the functional outcome as well as union time according to the prescribed scoring system. Final outcome was analyzed by SPSS-18 version. Level of significance was set at 0.05 (p<0.05). In this study exchange nailing with autogenous cancellous bone graft were done for femoral shaft fracture with nonunion in 13 patients. Mean±SD age was 39.08±5.780 years; Male: Female = 9:4. Among 13 nonunion fractures, all (100%) were united after exchange nailing with autogenous cancellous bone graft in aseptic condition. Mean union time was 26.97±2.976 weeks in static mode of fixation. Union time was highest in atrophic type of fracture and lowest in hypertrophic type of fracture. Final outcome according to modified Thoresen's score was satisfactory 92.29%; according to modified Silvia's score was 10.77±0.832. Exchange nailing with autogenous cancellous bone graft is an effective method of treatment in femoral shaft fracture with nonunion after intramedullary nailing. It provides a good scope to reinforce the optimum mechanical stability by a larger diameter nail and locked if necessary; as well as biological stimulation by reaming and bone grafting.