Taitsman et al identified risk factors associated with nonunion of a femoral shaft fracture after femoral nailing. These can help to identify a patient who may benefit from more aggressive management. The authors are from Harborview Medical Center in Seattle.


Patient selection: femoral shaft (diaphyseal) fracture treated with intramedullary nail placement


Nonunion was defined as a fracture that was unhealed after standard therapy and that required additional procedures to achieve union. Radiographic findings associated with nonunion included:

(1) persistent fracture line

(2) lack of bridging trabeculae

(3) cortical continuity on more than one cortex

(4) lack of resolution in these features on sequential radiographs


Risk factors for fracture nonunion:

(1) use of tobacco

(2) open fracture, especially if there was significant bone loss

(3) delay in weight bearing


Based on these findings:

(1) the patient should be encouraged to cease or reduce tobacco use

(2) the patient should start weight-bearing as soon as feasible


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