• Mohammad Naeem-ur- Razaq
  • Muhammad Qasim
  • Shahid Sultan


Background: There are many ways to treat aseptic non-union of femoral shaft fractures with reportedvaried success rate. Amongst all these, Exchange nailing is the simplest and most successful techniquefor treating aseptic non union of femoral shaft fractures. We have carried out a prospective study in theDepartment of Trauma & Orthopaedics, Ayub Medical College Abbottabad to analyse the role ofexchange nailing for aseptic non union of femoral shaft fractures. Methods: Forty-three femoral shaftaseptic non-unions in 41 consecutive patients were treated using exchange IM nailing, from January2006 to December 2007. The inclusion criteria for patients in the study was a femoral shaft fractures’aseptic non-union, has less than 1 Cm shortening with no segmental bone defect, and a radiolucent lineof the non-union, and which had previously been treated by intra-medullary nail. The surgical techniqueincluded removal of previously inserted intra-medullary nail, reaming of medullary cavity up to 2 mmabove the previous size, and re-insertion of statically locked exchange intra-medullary nail. Results:Forty-three femoral shaft aseptic non-union in 41 patients were treated; the mean age of the patientswas 38.81±13.75 years. Thirty-nine non-union out of total 43 cases (39/43) had healed giving a unionrate of 90%. Non-union persisted in the remaining four cases (4/43) in-spite of extended post operativefollow up of these patients for 18 months. Mean union was 4.97±1.53 months. No major surgicalcomplications were noted. Conclusion: Exchange nailing is a simple technique for treating aseptic nonunion of femoral shaft fractures. Based on the results of our study, we recommend it as the procedure ofchoice for non comminuted, aseptic non union of femoral shaft fracture.Keywords: Aseptic non-union, femoral non-union, exchange interlocking intra-medullary nailing


Court-Brown CM, Christie J, McQueen MM. Closed

intramedullary tibial nailing. Its use in closed and type I open

fractures. J Bone Joint Surg Br 1990;72:605–11.

Court-Brown CM, Keating JF, Christie J, McQueen MM.

Exchange intra medullary nailing. Its use in aseptic tibial

nonunion. J Bone Joint Surg Br 1995;77:407–11.

Herscovici D Jr, Ricci WM, McAndrews P, DiPasquale T,

Sanders R. Treatment of femoral shaft fracture using unreamed

interlocked nails. J Orthop Trauma 2000;14:10–4.

Grosse A, Christie J, Taglang G, Court-Brown C, McQueen M.

Open adult femoral shaft fracture treated by early intramedullary

nailing. J Bone Joint Surg Br 1993;75:562–5.

Brien PJ, Meek RN, Powell JN. Primary intramedullary nailing

of open femoral shaft fractures. J Trauma 1991;31:113–6.

Kempf I, Grosse A, Beck GF. Closed locked intramedullary

nailing: its application to comminuted fractures of the femur. J

Bone Joint Surg Am 1985;67:709–20.

Carlo B, William MR, Brett RB. Results of indirect reduction

and plating of femoral shaft nonunions after intramedullary

nailing. J Orthop Trauma 2001;15:254–63.

David JH, Stanley SL, James AG. Success of exchange reamed

intramedullary nailing for femoral shaft nonunion or delayed

union. J Orthop Trauma 2000;14:178–82.

Oh I, Nahigian SH, Rascher JJ, Farrall JP. Closed intramedullary

nailing for ununited femoral shaft fractures. Clin Orthop


Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and

reaming for delayed union of the femoral shaft. Clin Orthop


Danckwardt LG. Reaming of the medullary cavity and its effect

on diaphyseal bone. A fluorochromic, microangiographic and

histologic study on the rabbit tibia and dog femur. Acta Orthop

Scand Suppl 1969;128:1–153.

Whiteside LA, Ogata K, Lesker P, Reynolds FC. The acute

effects of periosteal stripping and medullary reaming on regional

bone blood flow. Clin Orthop Relat Res 1978;131:266–72.

Yu CW, Wu CC, Chen WJ. Aseptic Nonunion of a Femoral

Shaft Treated Using Exchange Nailing. Chang Gung Med J


Wu CC. The effect of dynamization on slowing the healing of

femur shaft fractures after interlocking nailing. J Trauma


Matelic TM Wang CJ, Chen HS, Chen CE, Yang KD. Treatment

of nonunions of long bone fractures with shock waves. Clin

Orthop 2001;381:95–101.

Bhandari M, Schemitsch EH. Clinical advances in the treatment

of fracture nonunion: the response to mechanical stimulation.

Curr Orthop 2000;11:372–7.

Nolte PA, van der Krans A, Patka P, Janssen IMC, Ryaby JP,

Albers GHR. Low-intensity pulsed ultrasound in the treatment of

nonunions. J Trauma 2001;51:693–703.

Wu CC, Chen WJ. Treatment of femoral shaft aseptic nonunions:

comparison between closed and open bone grafting techniques. J

Trauma 1997;43:112–6.

Perry CR. Bone repair techniques, bone graft, and bone graft

substitutes. Clin Orthop 1999;360:71–86.

Mark RB, Daniel PO. Exchange Nailing of Ununited Fractures. J

Bone Joint Surg Am 2007;89:177–88.

Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse

MJ. Failure of exchange reamed intramedullary nails for ununited

femoral shaft fractures. J Orthop Trauma 2000;14:335–8.

Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of ununited

femoral shaft fractures associated with locked nail breakage:

comparison between closed and open revision techniques. J

Orthop Trauma 1999;13:494–500.

Templeman D, Thomas M, Varecka T, Kyle R. Exchange

reamed intramedullary nailing for delayed union and nonunion of

the tibia. Clin Orthop Relat Res 1995;315:169–75.

Wei FC, El-Gammal TA, Lin CH, Ueng WN. Free fibula

osteoseptocutaneous graft for reconstruction of segmental

femoral shaft defects. J Trauma 1997;43:784–92.

Ahmad A, Saleh M, Hashmi M. Effects of smoking on healing of

nonunions in long bones. J Bone Joint Surg Br 2001;83:230.

Wu CC. Treatment of femoral shaft aseptic nonunion associated

with plating failure: emphasis on the situation of screw breakage.

J Trauma 2001;51:710–3.

Carlo B, William MR, Brett RB. Results of indirect reduction

and plating of femoral shaft nonunions after intramedullary

nailing. J Orthop Trauma 2001;15:254–63.

Wolinsky P, Tejwani N, Richmond JH, Koval KJ, Egol K,

Stephen DJG. Controversies in intramedullary nailing of femoral

shaft fractures. J Bone Joint Surg Am 2001;83:1404–15.



Most read articles by the same author(s)

1 2 > >>