Advertisement

Femoral non-union with malalignment: reconstruction and biological stimulation with the chipping technique

      Abstract

      Introduction

      The purpose of this study was to investigate the effectiveness of the chipping technique for the treatment of femoral non-unions associated with malalignment.

      Patients and methods

      A total of 21 femoral non-unions were managed with the chipping procedure and re-fixation. 15 of them had malalignment (angular or rotational deformity or limb length discrepancy). The deformities were simultaneously corrected by a combination of chipping and temporal external fixator. The median age of patients were 41 years (range, 19–73 years). The median time from injury or the final surgery to the initial chipping procedure was 24 months (range: 9–240 months). Femoral non-unions were classified as hypertrophic in 9, oligotrophic in 5 and atrophic in 7. Clinical and radiological assessment was performed.

      Results

      All femoral non-unions radiographically healed with one (19 cases) or two (2 cases) chipping procedures without bone grafting. Pre-existing angular deformity was corrected from 14° to 2°, external rotation 27° to 0°, and limb length discrepancy 16–7 mm. There were no major complications, although swelling of thigh and anemia was common after surgery.

      Conclusion

      Chipping the non-union site was associated with a favorable outcome. It biologically enhances fracture healing and should be considered as a treatment option for femoral non-unions with malalignment.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Canadian O
        Nonunion following intramedullary nailing of the femur with and without reaming. Results of a multicenter randomized clinical trial.
        J Bone Joint Surg Am. 2003; 85-A: 2093-2096
        • Taitsman LA
        • Lynch JR
        • Agel J
        • Barei DP
        • Nork SE
        Risk factors for femoral nonunion after femoral shaft fracture.
        J Trauma. 2009; 67: 1389-1392
        • Pihlajamaki HK
        • Salminen ST
        • Bostman OM
        The treatment of nonunions following intramedullary nailing of femoral shaft fractures.
        J Orthop Trauma. 2002; 16: 394-402
        • Ricci WM
        • Bellabarba C
        • Evanoff B
        • Herscovici D
        • DiPasquale T
        • Sanders R
        Retrograde versus antegrade nailing of femoral shaft fractures.
        J Orthop Trauma. 2001; 15: 161-169
        • Selvakumar K
        • Saw KY
        • Fathima M
        Comparison study between reamed and unreamed nailing of closed femoral fractures.
        Med J Malaysia. 2001; 56: 24-28
        • Brinker MR
        • O'Connor DP
        Exchange nailing of ununited fractures.
        J Bone Joint Surg Am. 2007; 89: 177-188
        • Kempf I
        • Grosse A
        • Rigaut P
        The treatment of noninfected pseudarthrosis of the femur and tibia with locked intramedullary nailing.
        Clin Orthop Relat Res. 1986; 212: 142-154
        • Webb LX
        • Winquist RA
        • Hansen ST
        Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases.
        Clin Orthop Relat Res. 1986; 212: 133-141
        • Harper MC
        Ununited fractures of the femur stabilized with the fluted rod.
        Clin Orthop Relat Res. 1984; 190: 273-278
        • Furlong AJ
        • Giannoudis PV
        • DeBoer P
        • Matthews SJ
        • MacDonald DA
        • Smith RM
        Exchange nailing for femoral shaft aseptic non-union.
        Injury. 1999; 30: 245-249
        • Hak DJ
        • Lee SS
        • Goulet JA
        Success of exchange reamed intramedullary nailing for femoral shaft nonunion or delayed union.
        J Orthop Trauma. 2000; 14: 178-182
        • Wu CC
        • Chen WJ
        Treatment of femoral shaft aseptic nonunions: comparison between closed and open bone-grafting techniques.
        J Trauma. 1997; 43: 112-116
        • Banaszkiewicz PA
        • Sabboubeh A
        • McLeod I
        • Maffulli N
        Femoral exchange nailing for aseptic non-union: not the end to all problems.
        Injury. 2003; 34: 349-356
        • 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: 335-338
        • Matsushita T
        • Watanabe Y
        Chipping and lengthening technique for delayed unions and nonunions with shortening or bone loss.
        J Orthop Trauma. 2007; 21: 404-406
        • Wu CC
        Treatment of femoral shaft aseptic nonunion associated with plating failure: emphasis on the situation of screw breakage.
        J Trauma. 2001; 51: 710-713
        • Bellabarba C
        • Ricci WM
        • Bolhofner BR
        Results of indirect reduction and plating of femoral shaft nonunions after intramedullary nailing.
        J Orthop Trauma. 2001; 15: 254-263
        • Borrelli Jr, J
        • Prickett WD
        • Ricci WM
        Treatment of nonunions and osseous defects with bone graft and calcium sulfate.
        Clin Orthop Relat Res. 2003; 411: 245-254
        • Watanabe Y
        • Takenaka N
        • Kobayashi M
        • Matsushita T
        Infra-isthmal fracture is a risk factor for nonunion after femoral nailing: a case-control study.
        J Orthop Sci. 2013; 18: 76-80
        • Jeanmart L
        • Baert AL
        • Wackenheim A
        Computer tomography of neck, chest, spine and limbs: atlas of pathologic computer tomography. Vol. 3. Springer-Verlag, Berlin1983: 171-177
        • Jaarsma RL
        • van Kampen A
        Rotational malalignment after fractures of the femur.
        J Bone Joint Surg Br. 2004; 86: 100-104
        • Sabharwal S
        • Kumar A
        Methods of assessing leg length discrepancy.
        Clin Orthop Relat Res. 2008; 466: 2910-2922
        • Santolini E
        • West R
        • Giannoudis PV
        Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence.
        Injury. 2015; 46: S8-19
        • Kanakaris NK
        • Tosounidis TH
        • Giannoudis PV
        Surgical management of infected nonunions: an update.
        Injury. 2015; 46: S25-S32
        • Olesen UK
        • Eckardt H
        • Bosemark P
        • Paulsen AW
        • Dahl B
        • Hede A
        The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases.
        Injury. 2015; 46: S44-S47
        • Giannoudis PV
        • Gudipati S
        • Harwood P
        • Kanakaris NK
        Long bone non-unions treated with the diamond concept: a case series of 64 patients.
        Injury. 2015; 46: S48-S54
        • Moghaddam A
        • Zietzschmann S
        • Bruckner T
        • Schmidmaier G
        Treatment of atrophic tibia non-unions according to “diamond concept”: results of one- and two-step treatment.
        Injury. 2015; 46: S39-S50
        • Ollivier M
        • Gay AM
        • Cerlier A
        • Lunebourg A
        • Argenson JN
        • Parratte S
        Can we achieve bone healing using the diamond concept without bone grafting for recalcitrant tibial nonunions?.
        Injury. 2015; 46: 1383-1388
        • Guimarães JA
        • Duarte ME
        • Fernandes MB
        • Vianna VF
        • Rocha TH
        • Bonfim DC
        • et al.
        The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft nonunions after locked intramedullary nailing.
        Injury. 2014; 45: S7-13
        • Alkhawashki HM
        Shock wave therapy of fracture nonunion.
        Injury. 2015; 46: 2248-2252
        • Shimizu T
        • Akahane M
        • Morita Y
        • Omokawa S
        • Nakano K
        • Kira T
        • et al.
        The regeneration and augmentation of bone with injectable osteogenic cell sheet in a rat critical fracture healing model.
        Injury. 2015; 46: 1457-1464
        • Perez Nunez MI
        • Ferreno Blanco D
        • Alfonso Fernandez A
        • Casado de Prado JA
        • Sanchez Crespo M
        • De la Red Gallego M
        • et al.
        Comparative study of the effect of PTH (1-84) and strontium ranelate in an experimental model of atrophic nonunion.
        Injury. 2015; 46: 2359-2367
        • Reed AA
        • Joyner CJ
        • Brownlow HC
        • Simpson AH
        Human atrophic fracture non-unions are not avascular.
        J Orthop Res. 2002; 20: 593-599
        • Dimitriou R
        • Mataliotakis GI
        • Angoules AG
        • Kanakaris NK
        • Giannoudis PV
        Complications following autologous bone graft harvesting from the iliac crest and using the RIA: a systematic review.
        Injury. 2011; 42: S3-15
        • Watanabe Y
        • Takaki M
        • Nishizawa Y
        • Kato N
        • Takenaka N
        • Matsushita T
        Chipping corrective osteotomy (CCO).
        Orthop Surg Traumatol. 2014; 57 ([in Japanese].): 833-841