Journal of Patient Safety & Quality Improvement

Journal of Patient Safety & Quality Improvement

Evaluation of Treatment Outcomes for Femoral Shaft Nonunion Fixed with Intramedullary Nail, with Addition of Plate and Bone Graft

Document Type : Original Article

Authors
Reza Noktehsanj 1
Ali Nami 1
Saeed Sadeghieh Ahari 2
Amir Javadi 1
1 Department of Surgery, School of Medicine, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran.
2 Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
10.22038/psj.2025.91761.1496
Abstract
Introduction:
Femoral shaft nonunion is a serious and challenging complication following intramedullary nailing requiring effective interventions to achieve successful bone union.

Materials and Methods:
In this retrospective cross-sectional study, 20 patients with femoral shaft nonunion previously treated with intramedullary nailing underwent revision surgery with augmentation plating and bone grafting.
Results:
The mean age of patients was 42.5 years, and 90% achieved complete bone union. The average union time was 16.2 weeks. Factors influencing outcomes included age, underlying diseases, fracture type, and the time to revision surgery. Compared to a historical control group treated with revision nailing alone, this study showed significantly reduced healing time and improved function. Limited complications included superficial infections managed conservatively.
Conclusion:
The findings highlight augmentation plating and bone grafting as an effective and reliable approach for treating femoral shaft nonunion after intramedullary nailing. Future prospective studies with larger samples and long-term follow-up are recommended to assess treatment durability and possible complications. Additionally, investigating factors affecting recovery and quality of life could improve treatment protocols.
Keywords
Nonunion
femoral shaft fracture
augmentation plating
bone graft
revision surgery
Subjects
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Journal of Patient Safety & Quality Improvement
Volume 14, Issue 1
Winter 2026
Pages 27-33