Single stage open reduction, intramedullary rod, bone grafting, and plate fixation for managing adolescent midshaft femoral fracture non-union, report of two cases

Although rare, long bones fracture non-union in pediatric and adolescent patients is still being reported. It poses a challenge for the trauma surgeons, although principles for adult patient management apply to pediatrics and adolescents; however, there is no standard protocol to deal with such situations. We report two male adolescent patients, 11 and 12 years old, presented with non-united midshaft femoral fracture non-union after being multiply operated on. One patient was diagnosed with a septic non-union, while the other had an atrophic type. Both were treated following the same technique of open surgery where debridement and refreshing of the fracture site were performed, followed by initial fixation using an intramedullary rod, the biological environment was then enhanced by the addition of autologous iliac bone graft, and the fixation was finalized using a 4.5 dynamic compression plate. Both patients achieved complete fracture union and excellent functional outcomes by the last follow up. Adolescent patients presented with multiply operated non-united femoral fracture could be successfully treated using the described technique. It improves the mechanical and biological environment with the advantage of being a single-stage surgery.