Abstract
Background
The aim of the study was to assess the outcome of internal fixation using two ordinary plates with autogenous bone grafting in the management of non-union of femoral shaft fractures over a period of eleven years.
Method
A retrospective study of double plating and autogenous bone grafting for un-united femoral shaft fractures performed by the two Senior Authors between 1996 and 2007. During this period, twenty-one cases were carried out. Details of preoperative, intra-operative, and postoperative findings were assessed. Postoperative follow up was recorded over a period of minimum two years.
The procedure was performed using two ordinary plates; a broad lateral and narrow anterior plates. Autogenous cancellous grafts from iliac crest were used in all of the cases, and in some, half fibulas were inserted through the medullary canal of the femur.
Results
A total of twenty-one patients were included in the study. All of them received previous treatment. The primary treatment was by intramedullary nailing in thirteen patients, uni-plating in four, external fixator in three, and traction in one.
The average age was 32 (range from 16 to 52). The average interval between the initial fracture and the treatment of the non-unions was 13 months (range from 6 to 28 months).
All wounds, both at fracture site and the graft donor site, healed primarily except one. That was at an iliac crest graft donor site, where superficial infection occurred, and was treated with antibiotics and healed 6 weeks later.
All patients achieved union on an average of 16 weeks (range from 12 to 28 weeks). There has been no failure in implants. The average lower limb shortening was 0.75 cm (range from 0.5 to 1.0 cm). No one requested shoe raise.
All the patients regained the preoperative range of motion at the hip and knee joints except four, who had limited flexion to 100 degrees.
Conclusion
We conclude that double plating with autogenous bone grafting is not only a convenient method to treat non-union of femoral shaft fractures as it requires minimal instrumentation and equipment, but it should also be considered as a safe and accepted treatment method as postoperatively patients can be discharged early on crutches, with a high success rate. It is less expensive, an important consideration in developing countries.
