[Recent advances in treatment of aseptic femoral shaft nonunion].

Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

[1]  P. Tang,et al.  Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation , 2017, Journal of Orthopaedic Surgery and Research.

[2]  P. Tang,et al.  Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union. , 2017, Injury.

[3]  C. Garnavos.  Treatment of aseptic non-union after intramedullary nailing without removal of the nail. , 2017, Injury.

[4]  Sang Bum Kim,et al.  Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note , 2016, Archives of Orthopaedic and Trauma Surgery.

[5]  J. W. Kim,et al.  Challenge to treat hypertrophic nonunion of the femoral shaft: the Poller screw augmentation technique , 2016, European Journal of Orthopaedic Surgery & Traumatology.

[6]  P. Tang,et al.  Double locking plate fixation for femoral shaft nonunion , 2016, European Journal of Orthopaedic Surgery & Traumatology.

[7]  D. Templeman,et al.  Nonunion of the Femur and Tibia: An Update. , 2016, The Orthopedic clinics of North America.

[8]  P. Giannoudis.  Treatment of bone defects: Bone transport or the induced membrane technique? , 2016, Injury.

[9]  M. El-Sayed,et al.  Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with significant shortening , 2016, European Journal of Orthopaedic Surgery & Traumatology.

[10]  M. Bhandari,et al.  Dynamizations and Exchanges: Success Rates and Indications , 2015, Journal of orthopaedic trauma.

[11]  A. Hede,et al.  The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases. , 2015, Injury.

[12]  Benjamin C. Taylor,et al.  Treatment of Bone Loss With the Induced Membrane Technique: Techniques and Outcomes , 2015, Journal of orthopaedic trauma.

[13]  C. Mauffrey,et al.  Innovative strategies for the management of long bone infection: a review of the Masquelet technique , 2015, Patient Safety in Surgery.

[14]  Cao Li,et al.  Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. , 2015, Injury.

[15]  Y. Niu,et al.  Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft nonunion: a retrospective cohort study. , 2015, Acta orthopaedica et traumatologica turcica.

[16]  J. Stoltz,et al.  Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. , 2015, Bio-medical materials and engineering.

[17]  J. M. Guimarães,et al.  The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing. , 2014, Injury.

[18]  Chunfeng Liu,et al.  Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing , 2014, International Orthopaedics.

[19]  Hamish Simpson,et al.  Delayed union and nonunions: epidemiology, clinical issues, and financial aspects. , 2014, Injury.

[20]  K. Egol,et al.  No advantage to rhBMP-2 in addition to autogenous graft for fracture nonunion. , 2014, Orthopedics.

[21]  Z. Pan,et al.  Augmentation plating in hypertrophic non-union after nail fixation of femoral shaft fracture compared with exchange plating. , 2014, Chinese medical journal.

[22]  M. Bhandari,et al.  Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta-analysis. , 2013, The bone & joint journal.

[23]  T. Mclaurin,et al.  The evolution of the Ilizarov technique: part 1: the history of limb lengthening. , 2013, Bulletin of the Hospital for Joint Disease.

[24]  T. Mclaurin,et al.  The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. , 2013, Bulletin of the Hospital for Joint Disease.

[25]  W. Walsh,et al.  Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes , 2013, Archives of Orthopaedic and Trauma Surgery.

[26]  Yu-Min Lin,et al.  Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. , 2012, Injury.

[27]  E. Pakos,et al.  Diagnostic and treatment modalities in nonunions of the femoral shaft: a review. , 2012, Injury.

[28]  T. Gosens,et al.  No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study , 2012, International Orthopaedics.

[29]  F. Fitoussi,et al.  Treatment of posttraumatic bone defects by the induced membrane technique. , 2012, Orthopaedics & traumatology, surgery & research : OTSR.

[30]  K. Yang,et al.  Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure , 2012, The journal of trauma and acute care surgery.

[31]  W. Obremskey,et al.  Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion. , 2011, Orthopedics.

[32]  Sul-Gee Kim,et al.  The Treatment of Nonisthmal Femoral Shaft Nonunions With IM Nail Exchange Versus Augmentation Plating , 2010, Journal of orthopaedic trauma.

[33]  M. Liebergall,et al.  The Outcome of Closed, Intramedullary Exchange Nailing With Reamed Insertion in the Treatment of Femoral Shaft Nonunions , 2009, Journal of orthopaedic trauma.

[34]  A. Schulz,et al.  Is the Wave Plate Still a Salvage Procedure for Femoral Non-union? Results of 75 Cases Treated with a Locked Wave Plate , 2009, European Journal of Trauma and Emergency Surgery.

[35]  P. Giannoudis,et al.  Prevalence of long-bone non-unions. , 2007, Injury.

[36]  P. Giannoudis,et al.  Femoral diaphyseal aseptic non-unions: is there an ideal method of treatment? , 2007, Injury.

[37]  D. P. O'connor,et al.  Exchange nailing of ununited fractures. , 2007, The Journal of bone and joint surgery. American volume.

[38]  A. Wentzensen,et al.  [Clinical experience with bone morphogenetic protein 7 (BMP 7) in nonunions of long bones]. , 2006, Der Unfallchirurg.

[39]  P. Giannoudis,et al.  Application of recombinant BMP-7 on persistent upper and lower limb non-unions. , 2005, Injury.

[40]  O. Farouk,et al.  The use of a locked plate in the treatment of ununited femoral shaft fractures. , 2004, The Journal of trauma.

[41]  D. P. O'connor,et al.  Ilizarov Compression Over a Nail for Aseptic Femoral Nonunions That Have Failed Exchange Nailing: A Report of Five Cases , 2003, Journal of orthopaedic trauma.

[42]  R. Simonis,et al.  Augmentative Ilizarov External Fixation After Failure of Diaphyseal Union With Intramedullary Nailing , 2002, Journal of orthopaedic trauma.

[43]  W. Ricci,et al.  Results of Indirect Reduction and Plating of Femoral Shaft Nonunions After Intramedullary Nailing , 2001, Journal of orthopaedic trauma.

[44]  G. Zych,et al.  Osteogenic Protein-1 (Bone Morphogenetic Protein-7) in the Treatment of Tibial Nonunions: A Prospective, Randomized Clinical Trial Comparing rhOP-1 with Fresh Bone Autograft* , 2001, The Journal of bone and joint surgery. American volume.

[45]  F. Fitoussi,et al.  [Reconstruction of the long bones by the induced membrane and spongy autograft]. , 2000, Annales de chirurgie plastique et esthetique.

[46]  M. Bosse,et al.  Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. , 2000, Journal of orthopaedic trauma.

[47]  S. Lee,et al.  Endoscopic bone graft for delayed union and nonunion. , 2000, Yonsei medical journal.

[48]  D. Macdonald,et al.  Exchange nailing for femoral shaft aseptic non-union. , 1999, Injury.

[49]  C. C. Wu,et al.  Effect of reaming bone grafting on treating femoral shaft aseptic nonunion after plating , 1999, Archives of Orthopaedic and Trauma Surgery.

[50]  S. Ueng,et al.  Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. , 1998, The Journal of trauma.

[51]  Y. Matsuda,et al.  Percutaneous autologous bone marrow transplantation for nonunion of the femur. , 1998, Nihon geka hokan. Archiv fur japanische Chirurgie.

[52]  C. C. Wu,et al.  Healing of 56 segmental femoral shaft fractures after locked nailing. Poor results of dynamization. , 1997, Acta orthopaedica Scandinavica.

[53]  C. C. Wu,et al.  The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. , 1997, The Journal of trauma.

[54]  S. Ueng,et al.  Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. , 1997, The Journal of trauma.

[55]  J. Mast,et al.  The use of endosteal substitution in the treatment of recalcitrant nonunions of the femur: report of seven cases. , 1996, Journal of orthopaedic trauma.

[56]  J. Healey,et al.  Percutaneous bone marrow grafting of delayed union and nonunion in cancer patients. , 1990, Clinical orthopaedics and related research.

[57]  L. Webb,et al.  Intramedullary Nailing and Reaming for Delayed Union or Nonunion of the Femoral Shaft: A Report of 105 Consecutive Cases , 1986, Clinical orthopaedics and related research.

[58]  V. T. Inman,et al.  TREATMENT OF NON-UNION OF FRACTURES OF THE LONG BONES BY THE TWO-PLATE METHOD. , 1964, The Journal of bone and joint surgery. American volume.

[59]  D. Phemister.  Treatment of ununited fractures by onlay bone grafts without screw or tie fixation and without breaking down of the fibrous union. , 1947, The Journal of bone and joint surgery. American volume.