Treatment of femoral shaft aseptic nonunions: Comparison between closed and open bone-grafting techniques

Objective: The aim of this prospective study was to investigate and compare the effects of closed and open bone-grafting techniques in the treatment of femoral shaft aseptic nonunions. Materials and Methods: Forty consecutive femoral shaft aseptic nonunions with inserted reamed intramedullary nails were randomly divided into two groups. The indications for these techniques were aseptic nonunions with less than 1 cm of shortening, no rotational or angular misalignment, and no large bony defects. The closed technique consisted of intramedullary reaming to a larger size and reinsertion of a stable intramedullary nail. The open technique consisted of local debridement, maintaining local stability with or without supplementation, and upper tibial cancellous bone grafting. Results: Thirty- five cases were followed up for at least 1 year (range, 1-3 years), and all achieved solid unions. There were no significant complications. The union period with the closed technique was significantly shorter than with the open technique (4.0 ± 0.6 months vs. 5.1 ± 0.8 months; p < 0.01, Student's t test). The operating time with the closed technique was also significantly shorter than with the open technique (36 ± 7 minutes vs. 58 ±14 minutes; p < 0.01, Student's t test). There was no significant difference in other parameters between the two techniques. Conclusions: The closed bone-grafting technique had clinical results similar to those of the open technique. The surgical procedure was simpler, however, and the union period was shorter. Whenever possible, therefore, the closed technique should be considered in all indicated cases.