Exchange nailing with open bone grafting for aseptic femoral diaphyseal nonunion with implant failure: A study of 13 cases

Introduction: In spite of vast advances in implants and operative techniques in the management of femoral diaphyseal fracture, treating a case of aseptic nonunion still poses a great challenge to treating surgeon. In India, the illiteracy of the patient and the false security of stable fixation with intramedullary rods often leads to premature weight bearing causing implant failure and nonunion. Material and methods: 13 patients aged 19 yrs - 52 yrs with aseptic femoral diaphyseal nonunion with implant failure were treated during Sept 2015 -Dec 2017. Twelve of them required opening nonunion site for implant removal, hence were treated by exchange nailing and autogenous bone grafts. One case treated by closed exchange nailing only.Results: 11 cases achieved solid osseous union with single procedure in an average of 5.3 months. One patient required dynamization in 4th post-operative month. A case of closed exchange nailing without bone grafting healed in 6 months.Conclusion: Exchange nailing with bone grafting is an excellent method for treating aseptic femoral diaphyseal nonunion with implant failure.