Femoral Shaft Nonunions

Fig. 10.1

Initial injury X-rays (a–c)

Fig. 10.2

Post-initial debridement and external fixation (a–c)

Fig. 10.3

Initial Masquelet technique after debridements (a, b)

Fig. 10.4

Massive bone grafting using the RIA or reamer-irrigator-aspirator (DePuy Synthes, Warsaw IN, USA) and bone morphogenetic protein-2 (off label) (Medtronic, Memphis TN, USA) (a, b)

Fig. 10.5

Femur shaft nonunion at 8 months postbone grafting (a, b)

Fig. 10.6

Femur shaft union after removal of plate, intramedullary nailing, and combination of autograft and allograft (a–d)

Case 2

18-year-old male with femoral shaft nonunion treated with a variety of techniques including initial intramedullary nail fixation, exchange intramedullary nailing and bone grafting, compression plating, and bone grafting. Femur healed after 10 months of treatments that required compression plating, intramedullary nail exchange, and bone grafting as final treatment (Figs. 10.7, 10.8, 10.9, 10.10 and 10.11).

Fig. 10.7

Initial femur postoperative X-ray s at 3 months with nonunion (a, b)

Fig. 10.8

Femur X-rays after exchange nailing and bone grafting (a, b)

Fig. 10.9

Femur X-ray after nail dynamization

Fig. 10.10

Immediate postoperative femur X-rays after compression plating in addition to previous exchange nailing and bone grafting with nail dynamization (a, b)

Fig. 10.11

Femur shaft union after compression plating in addition to previous exchange nailing and bone grafting with nail dynamization (a–d)

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