Study of nonunion fracture shaft femur in cases treated by intramedullary nailing in adults

Background: For many kinds of fractures of femoral shaft, interlocking intramedullary nailing (IMN) is regarded as the most effective definitive therapy. The aim of this work was to study and evaluate the factors that lead to nonunion fracture shaft femur in adults treated by IMN. Methods: The prospective and retrospective randomized study that carried out by 150 patients, with criteria of diaphyseal fractures shaft femur and closed fractures shaft femur. Antegrade nailing positioning the patient supine on a fracture table, skin traction was applied to the foot, that was put in a boot, the non-injured leg was positioned in hemi-lithotomy manner, abducted and flexed widely. Retrograde nailing: patient was put in supine position on fracture table with roll beneath the thigh to set the knee in a 30° flexed position, disinfect from above the iliac crest to the foot. Results: 11 cases had nonunion (7.33%), and 139 cases achieved successful union (92.67%). There was statistically significant relation between nonunion and BMI (P = 0.004), Diabetes Mellitus (DM) (P = 0.003), using Non-steroidal Anti-inflammatory Drugs (NSAIDs) (P = 0.008), there was statistically significant relation between nonunion type of fracture, nail size (reamed vs unreamed) and delayed weight bearing ( p <0.0001). Conclusions: Nonunion occurred in 7.33% of ILN for fracture shaft femur. Overweight, DM, NSAIDs, type of fractures, nail insertion without reaming and delayed weight bearing had a statistically significant relation with nonunion of femoral shaft fractures that were treated by IMN.