Abstract: Intramedullary nails have been widely used to treat long bone fractures, most of which heal within the expected time. However, in some cases union fails to occur by the expected time due to various reasons. After treatment with intramedullary nails, fractures located at the metaphysis of long bones are especially prone for non union. The main reason for the non union is instability (rotational) at the fracture site.
Exchange Nailing With or Without Bone Grafting: It is the gold standard treatment in cases of non union in interlocked femur, but it has certain limitations. Plate augmentation with bone grafting eliminated the rotational instability at the fracture and additional bone grafting stimulated fracture healing. Plate augmentation and bone grafting without removing the nail had more advantages such as shorter operation time, less invasiveness and early weight bearing after surgery than plate fixation after removing the nail.
Materials and Method: Our study is a prospective study conducted from AUG 2008 to NOV 2012, involving 10 patients. All patients were primarily treated with closed intramedullary interlocking nailing for femoral shaft fractures. The mean interval between the primary interlocking nailing and the augmentative plating and bone grafting was 11 months. (Range from 6 months to 2 years).
Results: All cases were followed up every 4 weeks upto 4 month and then every two months upto 2 years. All cases started showing signs of healing from 6 weeks onwards and the fracture united radiologically at the end of 4 months without any serious complication except in one case with mild soft tissue infection which was treated with intravenous antibiotics.
Conclusion: Our study shows that augmentation plating with bone grafting gives excellent mechanical stability and improves the biology for fracture healing with less complications and less chances for resurgery
