Augmented Stability in Leaving Original Internal Fixation with Multidimensional Cross Locking Plate through Mini‐Open Femoral Anterior Approach for Aseptic Femoral Shaft Nonunion: A Retrospective Cohort Study

Abstract

Objective Aseptic femoral shaft nonunion constitutes approximately 1%–10% of all femoral shaft fractures treated with intramedullary nail (IMN) fixation, possibly attributable to the lack of anti‐rotational stability. Although a lateral locking plate (LP) with retainment of original IMN has shown the most success, lateral LP inflicts significant surgical trauma on patients. Therefore, the Multidimensional Cross Locking Plate (MDC‐LP) was designed based on a mini‐open femoral anterior approach. We aim to report and compare the technical aspects and clinical outcomes of using anterior MDC‐LP or lateral LP with retention of original IMN for the treatment of aseptic femoral shaft nonunion. Methods In this single center retrospective cohort study, records of 49 patients who had undergone revision of femoral shaft aseptic nonunion with anterior MDC‐LP or lateral LP while retaining the original IMN from January 2015 to October 2019 were retrospectively reviewed. Information on patients' demographics, clinical data, and surgical outcomes were gathered and analyzed. X‐ray and CT scans were used for bone union evaluation and the lower extremity functional scale (LEFS) was used for follow‐up functional evaluation. For quantitative data, the Student's t‐test was used if the data were normally distributed. The Mann–Whitney U‐test was used for non‐normally distributed data. For qualitative data, the Chi‐square test was used for comparisons. Results Twenty‐seven patients were treated with anterior MDC‐LP, and 22 patients were treated with lateral LP. There are no significant differences in age, sex, BMI, time since initial femoral shaft fracture, initial fracture type (close/open), nonunion type, or nonunion location between patients' group. Among patients treated with anterior MDC‐LP, an average of 2‐months advantage in time to union was observed (4.09 months vs. 6.8 months in the lateral LP group: P = 0.000), smaller incision was required for MDC‐LP installment (7.7 cm vs 17.1 cm in lateral LP group: P = 0.000). Conclusions For the treatment of aseptic femoral shaft nonunion with retainment of original IMN, anterior MDC‐LP via mini‐open femoral anterior approach described in this study is a better option than lateral LP for achieving faster bone union and satisfactory functional outcome with less surgical trauma.

Keywords

• Augmentation plate
• Femoral shaft nonunion
• Femoral anterior approach
• Lateral locking plate
• Multidimensional cross locking plate