Augmented Plating and Bone Grafting in Treatment of Tibial and Femoral Shaft Nonunion

Background: Tibial and femoral nonunion is not unusual after intramedullary fixation and might lead to multiple surgical procedures and long-term disabilities. Different surgical techniques have been described for management of lower limb long bone nonunion primarily treated with intramedullary nailing. Despite the use of various procedures, the success rate of most of them are suboptimal, increases the risk of related complications and costs. Objectives: Augmented plating concomitant with autologous bone grafting technique make it possible to improve healing in a single operation. Methods: In this study, 19 patients with lower limb long bone nonunion were primarily fixed with intramedullary nails, were treated with augmented plating and autologous bone grafting and followed for one year. Results: The union rate was 94.7% with a mean union time of 4.75 months, 18 patients healed completely with solid union and only one case of femoral shaft nonunion remained. Infection and other surgical-related complications were not detected. After one year follow up, Visual Analog Scale was 31 ± 18.8, and decrement in active knee range of motion was more than 20% compared with opposite side in 47.4% of the patients. Conclusion: According to the results, the single stage augmented plating with locking plates combined with autologous bone grafting can be used as a useful method in treatment of femoral or tibial nonunion.