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Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure

Authors
 Yang, Kyu Hyun  ;  Kim, Jung Ryul  ;  Park, Jin 
Citation
 JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, Vol.72(2) : 60-64, 2012 
Journal Title
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY
ISSN
 2163-0755 
Issue Date
2012
MeSH
Adolescent ; Adult ; Aged ; Bone Nails* ; Female ; Femoral Fractures/diagnostic imaging ; Femoral Fractures/surgery* ; Fracture Fixation, Internal/methods* ; Fractures, Ununited/diagnostic imaging ; Fractures, Ununited/surgery* ; Humans ; Logistic Models ; Male ; Middle Aged ; Prosthesis Failure ; Radiography ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Keywords
Femoral shaft nonunion ; exchange nailing ; risk factor
Abstract
BACKGROUND: Although nail exchange with a larger diameter nail after additional reaming is typically considered the gold standard for failed femoral nailing, some reports question the role of exchange nailing. The purpose of this study was to evaluate the risk factors affecting the outcome of exchange nailing for femoral shaft nonunion after initial nailing.

METHODS: Forty-one consecutive patients treated with exchange nailing between November 1996 and March 2010 for femoral shaft nonunion that was initially managed with an intramedullary nailing were retrospectively reviewed. Possible risk factors and outcome (bony union) of exchange nailing were evaluated.

RESULTS: Of the 41 femoral shaft nonunions treated with exchange nailing, 9 (22%) failed to achieve bony union. The union rate for isthmal nonunions was 87% (27 of 31 cases) and for nonisthmal nonunions was 50% (5 of 10 cases). Univariate and multivariate logistic regression analyses demonstrated that the anatomic site (isthmal vs. nonisthmal) was a significant risk factor for exchange nailing failure (univariate, p = 0.021; multivariate, p = 0.016).

CONCLUSIONS: Although exchange nailing is an excellent choice for aseptic isthmal femoral shaft nonunion occurring after the initial nailing, other treatment options such as augmentative plating should be considered for nonisthmal femoral shaft nonunions.
Full Text
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01586154-201202000-00049&LSLINK=80&D=ovft
DOI
22327999
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Yang, Kyu Hyun(양규현) ORCID logo https://orcid.org/0000-0001-7183-588X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/91179
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