The treatment of nonunion of femoral shaft fractures after intramedullarynaildynamizationwith temporary compression using external fixator followed by relocking of the internal intramedullary nail

Objective To introduce the technique we invented to treat hypertrophic and oligotrophic nonunion of femoral shaft fracture after dynamization of intramedullary nail (IMN) and to report its preliminary results. Methods The data of 2 cases with hypertrophic nonunions of femoral shaft fracture and 1 case with oligotrophic nonunion following IMN dynamization who had been treated by the technique from March 2006 to July 2017 in Beijing Jishuitan hospital were retrospectively studied. There were 2 females and 1 male, aged 50, 66 and 24 years old. 2 parallel half pins were inserted from anterior to posterior at the trochanteric and condylar zones of the femur for antegrade intramedullary nailing patients, and from lateral to medial sides for retrograde intramedullary nailing patient respectively, then the pins were connected with monolateral limb reconstruction fixator. The fracture nonunion site was compressed by the fixator up to 10-15 mm. The holes at the end of intramedullary nail where their screws were removed for dynamization were locked again with 2 locking screws, and then the frame was removed. The patients are allowed to start their rehabilitation and fully bear their body weight 1 day after the operation. Results The three patients were followed up for 25, 22, and 7 months after the surgery, respectively. The X-ray films showed the fracture healed at 7 months in two case, and at 12 months in one. One patient got her nail removed 25 months after the operation, feeling good 37 months after the removal. Conclusion This technique is an option to manage the hypertrophic and oligotrophic fracture nonunion of the femur after dynamization of IMN. It is mini-invasive to the nonunion site, easy to practice and allows early rehabilitation. Key words: Femoral fractures; Fractures, ununited; Fracture fixation, intramedullary; External fixators