• Jin Park, Sul Gee Kim, Han Kook Yoon, and Kyu Hyun Yang.
• Department of Orthopaedic Surgery, Aju University School of Medicine, Suwon, South Korea.
• J Orthop Trauma. 2010 Feb 1;24(2):89-94.

ObjectivesThe purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing.Design: Retrospective data analysis, November 1996-March 2006.SettingA level I trauma center.PatientsEighteen patients with 18 nonisthmal femoral nonunions.InterventionSeven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting.Main Outcome MeasureUnion and complications.ResultsFive nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002).ConclusionsAP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

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