Altern Ther Health Med. 2023 Nov;29(8):750-753.
Failure of bone healing after intramedullary nailing (IMN) of a femoral diaphyseal fracture is an uncommon condition, which can cause obvious pain symptoms and seriously affect the daily life of patients. Ununion of femoral fracture requires treatment to promote successful bone union. Augmentative plating (AP) has yielded good results in treating femoral nonunion after IMN. However, there are few large cohort studies and no technical standard for this treatment. To determine (1) the proportion of individuals with femoral nonunion after IMN who achieved radiographic signs of osseous union following the additional treatment of AP and autogenous bone grafting and (2) the factors associated with the failure of this treatment.
Nonunion after IMN fixation is defined as an unhealed fracture with no radiographic signs of osseous union at least six months after IMN treatment. Osseous union as bridging bone on three of four cortices with the absence of a radiolucent line. Between January 2011 and January 2022, 83 individuals diagnosed with femoral nonunion after IMN fixation underwent AP and an autogenous bone graft.
Seventy-six of the 83 nonunion individuals attained osseous union by 12 months. Six of 36 (16.7%) subjects with mono-cortical plates had non-union. Conversely, one of 47 subjects (2%) with bi-cortical plates had non-union. There were 18 individuals whose AP had ≤6 cortices. Five of these 18 (38.5%) individuals had non-union. Two of 65 with an AP of >6 cortices had non-union. AP with ≤ 6 cortices was a major risk factor for the likelihood of unsuccessful procedures compared to AP with > 6 cortices. Three individuals experienced incision infection at the bone graft harvest site and were treated with local wound care.
A high proportion of individuals with femoral nonunion after IMN fixation were salvaged by AP and an autogenous bone graft. Bi-cortical plate and screw intersection of more than six cortices may increase the treatment effectiveness.
There were limitations of this study. First, it was a retrospective study over a 10-year period, and the patients were treated by different orthopedic surgeons. Second, lack of functional evaluation is another limitation of the present work.
The technique of bi-cortical plate and screw intersection of more than six cortices is not difficult for experienced orthopedic surgeons, and no special surgical tools is required.
Many literature has confirmed the good effect of APP technology in treating femoral nonunion after intramedullary nail fixation, but there are still cases of failure. Our study may enable this technology to achieve better therapeutic effects.
股骨干骨折髓内钉固定后骨不愈合是一种罕见的情况，可引起明显的疼痛症状，严重影响患者的日常生活。股骨干骨折不愈合需要治疗以促进骨愈合。附加接骨板（AP）在治疗髓内钉固定后股骨干不愈合方面取得了良好的效果。然而，对于这种治疗方法，很少有大的队列研究，也没有技术标准。目的是：（1）确定在附加 AP 和自体骨移植治疗后，影像学显示骨愈合的股骨干不愈合患者的比例；（2）确定与该治疗失败相关的因素。
髓内钉固定后不愈合定义为髓内钉治疗至少 6 个月后仍无影像学骨愈合迹象的骨折。骨愈合是指在四个皮质中的三个皮质上有桥接骨，没有透光线。2011 年 1 月至 2022 年 1 月，83 例诊断为髓内钉固定后股骨干不愈合的患者接受了 AP 和自体骨移植。
76 例非愈合患者在 12 个月时达到骨愈合。36 例单皮质板中有 6 例（16.7%）不愈合。相反，47 例双皮质板中有 1 例（2%）不愈合。有 18 例患者的 AP 少于 6 个皮质。这 18 例中有 5 例（38.5%）不愈合。65 例 AP 大于 6 个皮质中有 2 例不愈合。与 AP 大于 6 个皮质相比，AP 小于等于 6 个皮质是手术失败的主要危险因素。3 例患者在取骨部位发生切口感染，经局部伤口护理治疗。
AP 和自体骨移植治疗股骨干骨折髓内钉固定后不愈合的患者比例较高。双皮质板和螺钉交叉超过 6 个皮质可能会增加治疗效果。
本研究存在一定的局限性。首先，这是一项回顾性研究，研究时间为 10 年，患者由不同的骨科医生治疗。其次，缺乏功能评估是目前工作的另一个局限性。
对于经验丰富的骨科医生来说，双皮质板和螺钉交叉超过 6 个皮质的技术并不难，也不需要特殊的手术工具。
许多文献已经证实 APP 技术在治疗髓内钉固定后股骨干不愈合方面的良好效果，但仍有失败的病例。我们的研究可能使这项技术取得更好的治疗效果。
