Deepak Singh Patel, Rahul Verma, Vaibhav Jain, Manish Singh Rajpoot, Ashish Dehare, Saurav Mukhopadhyay
Augmentation plating with selective autologous bone grafting delivers 100% union rates with predictable healing timelines and near-normal functional recovery in aseptic femoral and tibial non-unions. The technique is mechanically sound, biologically preserving, and operatively efficient - making it a reliable first-choice revision strategy in this clinical setting.
INTRODUCTION: Non-union of long bone fractures after intramedullary nailing (IMN) remains a demanding clinical challenge. Augmentation plating - applying a supplementary plate over the retained nail - offers superior rotational control without the morbidity of nail extraction. This prospective study evaluated clinical, radiological, and functional outcomes of this technique for aseptic femoral and tibial non-unions.
MATERIALS AND METHODS: Thirty patients with aseptic diaphyseal non-union of the femur or tibia underwent augmentation plating with selective autologous bone grafting (April 2024-September 2025). Radiological healing was assessed by the modified Radiographic Union Score for Tibia (mRUST). Functional recovery was quantified by the lower extremity functional scale (LEFS) and Wu's criteria.
RESULTS: All 30 patients (17 femoral, 13 tibial) achieved radiological union, representing a 100% union rate. Mean time to union was 6.23 ± 0.82 months (range 5-8 months). Femoral non-unions healed significantly faster than tibial non-unions (5.88 vs. 6.69 months; P = 0.005). The mean mRUST score improved from 5.17 ± 0.79 preoperatively to 15.33 ± 0.84 at final follow-up (P < 0.001). Mean LEFS improved from 31.77 ± 3.39 to 76.60 ± 3.77 (P < 0.001). By Wu's criteria, 60% achieved excellent and 30% achieved good results; no patient had a poor outcome. The complication rate was 10%, comprising two superficial infections managed conservatively and one deep infection managed with debridement, antibiotics, and implant retention; fracture union was achieved in all three.
CONCLUSION: Augmentation plating with selective autologous bone grafting delivers 100% union rates with predictable healing timelines and near-normal functional recovery in aseptic femoral and tibial non-unions. The technique is mechanically sound, biologically preserving, and operatively efficient - making it a reliable first-choice revision strategy in this clinical setting.