Intramedullary nailing as a treatment for non-unions of femoral shaft fractures after plating failure: A case series

INTRODUCTION: The management of implant failure in femoral shaft fractures remains a challenging problem for orthopaedic surgeons. This series aim to evaluate the effectiveness of intramedullary (IM) nailing for treating femoral shaft nonunions after implant failure. CASE PRESENTATION: Three patients presented with pain after walking on crutch and limping with history of fixation using plate for femoral shaft fracture. Implant removal was then performed with subsequent refixation using intramedullary nailing with A2FN. The Lower Extremity Functional Score and Visual Analogue Score evaluation showed excellent result in these patients. CLINICAL DISCUSSION: IM nailing is the mainstay of treatment for patients with femoral shaft fractures. This intervention provides support to fractures and aid in union of fractures. Several advantages have been reported in IM nailing, including shorter length of stay, rapid union, and early functional capacity of the limb. Insertion of IM nailing may preserve anatomical structure in the patients, which leads to better improvement of functional capacity. Nailing also limits soft tissue damage. Thus, in patients presented with previous plate failure similar to our patients, IM nailing with reaming is recommended. CONCLUSION: Nonunion after femoral shaft plating are common. Nailing conversion is one of available treatment options to achieve maximum recover in this type of case.