• Eli A Swanson, Eli C Garrard, Derek T Bernstein, Daniel P OʼConnor, and Mark R Brinker.
• *Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX; †Department of Orthopaedic Trauma, The University of Texas Medical School at Houston, Houston, TX; ‡Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX; and §Department of Health and Human Performance, University of Houston, Houston, TX.
• J Orthop Trauma. 2015 Jan 1; 29 (1): 21-7.

ObjectivesTo evaluate the radiographic and clinical outcomes of a systematic approach to exchange nailing for the treatment of aseptic femoral nonunions previously treated with an intramedullary nail.DesignRetrospective cohort.SettingTertiary referral center.PatientsFifty aseptic femoral nonunions in 49 patients who presented with an intramedullary nail in situ an average of 25 months after the initial fracture nailing were evaluated.InterventionOur systematic approach includes inserting an exchange nail at least 2 mm larger in diameter than the in situ nail, using a different manufacturer's nail, static interlocking, correction of any metabolic and endocrine abnormalities, and secondary nail dynamization in cases showing slow progression toward healing.Main Outcomes MeasurementsThe outcome measures were radiographic and clinical evidence of nonunion healing and time to union.ResultsAll 50 femoral nonunions (100%) healed after this systematic approach to exchange nailing. The average time to achieve union was 7 months (range, 3-26 months).ConclusionsUtilization of this systematic approach of exchange nailing for the treatment of aseptic femoral nonunions resulted in a 100% healing rate.Level Of EvidenceTherapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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