A 1:1 matched-pair comparative study of minimally invasive elastic Poller wire augmentation vs. standard augmentative plating for hypertrophic femoral non-union after intramedullary nailing.

BACKGROUND: The primary cause of hypertrophic non-union following femoral intramedullary nailing (IMN) is mechanical instability rather than the depletion of biological activity. Although standard augmentative plating can provide excellent stability, it typically necessitates extensive surgical exposure and periosteal stripping, which disrupts the fragile local vascular network. This study aimed to introduce a novel, minimally invasive elastic Poller wire technique and compare its clinical efficacy and perioperative surgical trauma with those of standard augmentative plating. METHODS: This retrospective cohort study included 32 patients with hypertrophic femoral non-union with a retained IMN treated between 2017 and 2025. To control for selection bias, a 1:1 matched-pair design was utilized. The patients were assigned to two groups based on the surgical intervention: the Poller wire group (n = 16) underwent the minimally invasive elastic Poller wire technique; the plate group (n = 16) consisted of patients who underwent standard open augmentative plating, strictly matched to the Poller wire group based on baseline characteristics including age, gender, and time to non-union. The primary outcome measures were the radiographic bone union rate and time to union. Secondary outcomes included operative time, intraoperative blood loss, incision length, and the incidence of complications. RESULTS: All 32 patients (100%) successfully achieved solid bone union. There was no significant difference in the mean time to union between the plate and Poller wire groups (5.1 ± 1.2 vs. 4.9 ± 1.1 months, P = 0.584). However, the Poller wire group demonstrated significant advantages in perioperative parameters, including a shorter incision length (4.2 ± 0.8 vs. 16.5 ± 2.4 cm, P < 0.001), shorter operative time (42.3 ± 8.5 vs. 118.5 ± 15.6 min, P < 0.001), and substantially reduced intraoperative blood loss (45.0 ± 12.5 vs. 350.5 ± 65.2 ml, P < 0.001). Furthermore, all patients in the plate group required inpatient admission for a secondary major surgery for implant removal, whereas all implants in the Poller wire group were successfully removed via a minimally invasive approach under local anesthesia. CONCLUSION: For hypertrophic femoral non-union, the minimally invasive elastic Poller wire technique provides adequate mechanical stability, achieving a 100% union rate comparable to the gold standard of augmentative plating. By maximally preserving the biological healing envelope and significantly reducing surgical trauma and medical costs, this technique represents a highly promising minimally invasive alternative in clinical practice.