Recent advances in treatment of aseptic femoral shaft nonunion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Wei , CHEN Hua ,  TANG Peifu

Department of Orthopedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

TANG Peifu, Email: pftang301@163.com

Keywords：

Aseptic femoral shaft nonunion; surgical treatment; intramedullary nail; plate; biological stimulants

DOI：

10.7507/1002-1892.201712089

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To review the recent advances in treatment of aseptic femoral shaft nonunion. Methods The clinical studies about the treatments of aseptic femoral shaft nonunion in recent years were widely reviewed and analyzed. Results There are several surgical methods for aseptic femoral shaft nonunion. Due to uncertain clinical outcome, dynamization of nail should be carefully selected. The exchange nailing is suitable for the hypertrophic nonunion of the isthmal femoral shaft fracture. The exchange lateral plating is suitable for nonunion with obvious malformation. However, wave plate or dual plate should be chosen when the bone nonuinon is combined with the medial defect. The augmentation plating improves the success rate of nailing for femoral shaft nonunion, but it should be carefully selected for patients with obvious deformity or bone defect. Ilizarov technique is suitable for various bone nonunion, especially with complicated or large segmental bone defects. Induced membrane technique is also an important method for the treatment of bone nonunion with large bone defects. The clinical efficacy of the blocking screw remains to be supported by further evidence. Biological stimulants are mainly used for atrophic nonunion, and the clinical efficacy of them alone are still controversial. Conclusion Due to lack of comparative studies between different surgical methods, the orthopedist should choose the appropriate treatment according to the individual situations of the patient and the types of bone nonunion.

Citation： ZHANG Wei, CHEN Hua, TANG Peifu. Recent advances in treatment of aseptic femoral shaft nonunion. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(5): 519-525. doi: 10.7507/1002-1892.201712089 Copy

1.	Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fracture in adults. Philadelphia: Wolters Kluwer Health, 2015: 2216-2221.
2.	Tzioupis C, Giannoudis PV. Prevalence of long-bone non-unions. Injury, 2007, 38 Suppl 2: S3-9.
3.	Hak DJ, Fitzpatrick D, Bishop JA, et al. Delayed union and nonunion: Epidemiology, clinical issues, and financial aspects. Injury, 2014, 45 Suppl 2: S3-7.
4.	Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
5.	Gelalis ID, Poltis AN, Arnaoutolou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft. A review. Injury, 2012, 43(7): 980-988.
6.	Richter J, Schulze W, Muhr G. Diaphyseal femur pseudarthroses—only a technical problem? Chirurg, 2000, 71(9): 1098-1106.
7.	Peng Y, Ji X, Zhang L, et al. Double locking plate fixation for femoral shaft nonunion. Eur J Orthop Surg Traumatol, 2016, 26(5): 501-507.
8.	Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin N Am, 2016, 47(2): 365-375.
9.	Crowley DJ, Kanakaris NK, Giannouds PV. Femoral diaphyseal aspetic non-unions: Is there an ideal method of treatment. Injury, 2007, 38 Suppl 2: S55-63.
10.	Chadayammuri V, Hake M, Mauffrey C. Innovative strategies for the management of long bone infection: a review of the Masquelet technique. Patient Saf Surg, 2015, 9: 32.
11.	Huang KC, Tong KM, Lin YM, et al. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury, 2012, 43(10): 1747-1752.
12.	Litrenta J, Tornetta P 3rd, Vallier H, et al. Dynamizations and exchanges: success rates and indications. J Orthop Trauma, 2015, 29(12): 569-573.
13.	Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma, 1997, 43(2): 263-267.
14.	Wu CC, Chen WJ. Healing of 56 segmental femoral shaft fractures after locked nailing. Poor results of dynamization. Acta Orthop Scand, 1997, 68(6): 537-540.
15.	Rommens PM, Hessmann MH. Intramedullary nailing. Berlin: Springer, 2012: 419-452.
16.	Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop Relat Res, 1986, (212): 133-141.
17.	Wu CC, Shih CH, Chen WJ, et al. Effect of reaming bone grafting on treating femoral shaft aseptic non-union after plating. Arch Orthop Trauma Surg, 1999, 119: 303-307.
18.	Furlong AJ, Giannoudis PV, DeBoer P, et al. Exchange nailing for femoral shaft aseptic non-union. Injury, 1999, 30(4): 245-249.
19.	Weresh MJ, Hakanson R, Stover MD, et al. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma, 2000, 14(5): 335-338.
20.	Shroeder JE, Mosheiff R, Khoury A, et al. The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma, 2009, 23(9): 653-657.
21.	Yang KH, Kim JR, Park J. Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure. J Trauma Acute Care Surg, 2012, 72(2): E60-64.
22.	Schulz AP, Faschingbauer M, Seide K, et al. Is the wave plate still a salvage procedure for femoral non-union? Results of 75 cases treated with a locked wave plate. Eur J Trauma Emerg Surg, 2009, 35(2): 127-131.
23.	Ricci WM, Ostrum RF. Orthopaedic knowledge update-Trauma 5. Rosemont: AAOS, 2016: 96-159.
24.	Marti RK, Kloen P. Concepts and Cases in Nonunion Treatment. New York: Thieme, 2011: 560-649.
25.	Bellabarba C, Ricci WM, Bolhofner BR. Results of indirect reduction and plating of femoral shaft non-unions after intramedullary nailing. J Orthop Trauma, 2001, 15(4): 254-263.
26.	Abdel-Aa AM, Farouk OA, Elsayed A, et al. The use of a locked plate in the treatment of ununited femoral shaft fractures. J Trauma, 2004, 57(4): 832-836.
27.	Murray WR, Lucas DB, Inman VT. Treatment of nonunion of fractures of the long bones by the two-plate method. J Bone Joint Surg (Am), 1964, 46-A(5): 1027-1048.
28.	Matelic T, Monroe MT, Mast JW. The use of endosteal substitution in the treatment of recalcitrant non-unions of the femur: report of seven cases. J Orthop Trauma, 1996, 10(1): 1-6.
29.	Maimaitiyiming A, Amat A, Rehei A, et al. Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury, 2015, 46(6): 1102-1107.
30.	Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
31.	Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma, 1998, 45(4): 747-752.
32.	Garnavos C. Treatment of aseptic non-union after intramedullary nailing without removal of the nail. Injury, 2017, 48 Suppl 1: S76-S81.
33.	Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft non-unions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
34.	茹江英, 仓海滨, 胡传亮, 等. 两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较. 中国修复重建外科杂志, 2013, 27(1): 25-29.
35.	Ru JY, Niu YF, Cong Y, et al. Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft non-union: a retrospective cohort study. Acta Orthop Traumatol Turc, 2015, 49(6): 668-675.
36.	Jiang LJ, Pan ZJ, Zheng Q. Augmentation plating in hypertrophic non-union after nail fixation of femoral shaft fracture compared with exchange plating. Chinese Medical Journal (Engl), 2014, 127(16): 2900-2905.
37.	Wang Z, Liu C, Liu C, et al. Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing. Int Orthop, 2014, 38(11): 2343-2347.
38.	Yang KH, Won Y, Kim SB, et al. Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note. Arch Orthop Trauma Surg, 2016, 136(10): 1381-1385.
39.	Jordan CJ, Goldstein RY, McLaurin TM, et al. The evolution of the Ilizarov technique: part 1: the history of limb lengthening. Bull Hosp Jt Dis (2013), 2013, 71(1): 89-95.
40.	Goldstein RY, Jordan CJ, McLaurin TM, et al. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis, 2013, 71(1): 96-103.
41.	Zhang Q, Zhang W, Zhang Z, et al. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res, 2017, 12(1): 183.
42.	Zhang Q, Zhang W, Zhang Z, et al. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union. Injury, 2017, 48(10): 2270-2275.
43.	Menon DK, Dougall TW, Pool RD, et al. Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma, 2002, 16(7): 491-497.
44.	Brinker MR, O’Connor DP. Ilizarov compression over a nail for aseptic femoral nonunions that have failed exchange nailing: a report of five cases. J Orthop Trauma, 2003, 17(10): 668-676.
45.	Azzam W, El-Sayed M. Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with siginificant shortening. Eur J orthop Surg Traumatol, 2016, 26(3): 319-328.
46.	Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta analysis. Bone Joint J, 2013, 95-B(12): 1673-1680.
47.	Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
48.	Taylor BC, Hancock J, Zitzke R, et al. Treatment of bone loss with the induced membrane technique: techniques and outcomes. J Orthop Trauma, 2015, 29(12): 554-557.
49.	Olesen UK, Eckardt H, Bosemark P, et al. The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases. Injury, 2015, 46 Suppl 8: S44-47.
50.	Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1): 97-102.
51.	Editorial. Treatment of bone defects: bone transport or the induced membrane technique? Injury, 2016, 47: 291-292.
52.	Eom TW, Kim JJ, Oh HK, et al. Challenge to treat hypertrophic nonunion of the femoral shaft: the poller screw augmentation technique. Eur J Surg Traumatol, 2016, 26(6): 559-563.
53.	Phemister DB. Treatment of ununited fractures by only bone grafts without screw or tie fixation and without breaking down of the fibrous union. J Bone Joint Surg (Am), 1947, 29(4): 946-960.
54.	Chapman MW, Finkemeier CG. Treatment of supracondylar nonunion of the femur with plate fixation and bone graft. J Bone Joint Surg (Am), 1999, 81(9): 1217-1228.
55.	Kim SJ, Shin SJ, Yang KH, et al. Endoscopic bone graft for delayed union and nonunion. Yonsei Med J, 2000, 41(1): 107-111.
56.	Healey JH, Zimmerman PA, McDonnell JM, et al. Percutaneous bone marrow grafting of delayed union and nonunion in cancer patients. Clin Orthop Relat Res, 1990, (256): 280-285.
57.	Matsuda Y, Sakayama K, Okumura H, et al. Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nihon Geka Hokan, 1998, 67(1): 10-17.
58.	Guimarães JA, Duarte ME, Fernandes MB, et al. The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing. Injury, 2014, 45 Suppl 5: S7-S13.
59.	Gross JB, Diligent J, Bensoussan D, et al. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Biomed Mater Eng, 2015, 25(1 Suppl): 187-197.
60.	付维力, 李祺, 李箭. 富血小板血浆在临床骨科中的应用进展. 中国修复重建外科杂志, 2014, 28(10): 1311-1316.
61.	Malhotra A, Pelletier MH, Yu Y, et al. Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes. Arch Orthop Trauma Surg, 2013, 133(2): 153-165.
62.	高怡加, 陈柏行, 黄枫, 等. 富血小板血浆联合植骨治疗骨不连疗效的Meta分析. 中华关节外科杂志, 2017, 11(2): 171-175.
63.	Peerbooms JC, Colaris JW, Hakkert AA, et al. No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study. Int Orthop, 2012, 36(10): 2113-2119.
64.	Tressler MA, Richards JE, Sofianos D, et al. Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion. Orthopedics, 2011, 34(12): e877-884.
65.	Takemoto R, Forman J, Taormina DP, et al. No advantage to rhBMP-2 in addition to autogenous graft for fracture nonunion. Orthopedics, 2014, 37(6): e525-530.
66.	Friedlaender GE, Perry CR, Cole JD, et al. Osteogenic protein-1(bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg (Am), 2001, 83-A Suppl 1(Pt 2): S151-158.
67.	Dimitriou R, Dahabreh Z, Katsoulis E, et al. Application of recombinant BMP-7 on persistent upper and lower limb non-unions. Injury, 2005, 36 Suppl 4: S51-59.
68.	Zimmermann G, Moghaddam A, Wagner C, et al. Clinical experience with bone morphogenetic protein 7(BMP 7) in nonunions of long bones. Unfallchirurg, 2006, 109(7): 528-537.

1. Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fracture in adults. Philadelphia: Wolters Kluwer Health, 2015: 2216-2221.
2. Tzioupis C, Giannoudis PV. Prevalence of long-bone non-unions. Injury, 2007, 38 Suppl 2: S3-9.
3. Hak DJ, Fitzpatrick D, Bishop JA, et al. Delayed union and nonunion: Epidemiology, clinical issues, and financial aspects. Injury, 2014, 45 Suppl 2: S3-7.
4. Brinker MR, O’Connor DP. Exchange nailing of ununited fractures. J Bone Joint Surg (Am), 2007, 89(1): 177-188.
5. Gelalis ID, Poltis AN, Arnaoutolou CM, et al. Diagnostic and treatment modalities in nonunions of the femoral shaft. A review. Injury, 2012, 43(7): 980-988.
6. Richter J, Schulze W, Muhr G. Diaphyseal femur pseudarthroses—only a technical problem? Chirurg, 2000, 71(9): 1098-1106.
7. Peng Y, Ji X, Zhang L, et al. Double locking plate fixation for femoral shaft nonunion. Eur J Orthop Surg Traumatol, 2016, 26(5): 501-507.
8. Bell A, Templeman D, Weinlein JC. Nonunion of the femur and tibia: an update. Orthop Clin N Am, 2016, 47(2): 365-375.
9. Crowley DJ, Kanakaris NK, Giannouds PV. Femoral diaphyseal aspetic non-unions: Is there an ideal method of treatment. Injury, 2007, 38 Suppl 2: S55-63.
10. Chadayammuri V, Hake M, Mauffrey C. Innovative strategies for the management of long bone infection: a review of the Masquelet technique. Patient Saf Surg, 2015, 9: 32.
11. Huang KC, Tong KM, Lin YM, et al. Evaluation of methods and timing in nail dynamisation for treating delayed healing femoral shaft fractures. Injury, 2012, 43(10): 1747-1752.
12. Litrenta J, Tornetta P 3rd, Vallier H, et al. Dynamizations and exchanges: success rates and indications. J Orthop Trauma, 2015, 29(12): 569-573.
13. Wu CC. The effect of dynamization on slowing the healing of femur shaft fractures after interlocking nailing. J Trauma, 1997, 43(2): 263-267.
14. Wu CC, Chen WJ. Healing of 56 segmental femoral shaft fractures after locked nailing. Poor results of dynamization. Acta Orthop Scand, 1997, 68(6): 537-540.
15. Rommens PM, Hessmann MH. Intramedullary nailing. Berlin: Springer, 2012: 419-452.
16. Webb LX, Winquist RA, Hansen ST. Intramedullary nailing and reaming for delayed union or nonunion of the femoral shaft. A report of 105 consecutive cases. Clin Orthop Relat Res, 1986, (212): 133-141.
17. Wu CC, Shih CH, Chen WJ, et al. Effect of reaming bone grafting on treating femoral shaft aseptic non-union after plating. Arch Orthop Trauma Surg, 1999, 119: 303-307.
18. Furlong AJ, Giannoudis PV, DeBoer P, et al. Exchange nailing for femoral shaft aseptic non-union. Injury, 1999, 30(4): 245-249.
19. Weresh MJ, Hakanson R, Stover MD, et al. Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma, 2000, 14(5): 335-338.
20. Shroeder JE, Mosheiff R, Khoury A, et al. The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma, 2009, 23(9): 653-657.
21. Yang KH, Kim JR, Park J. Nonisthmal femoral shaft nonunion as a risk factor for exchange nailing failure. J Trauma Acute Care Surg, 2012, 72(2): E60-64.
22. Schulz AP, Faschingbauer M, Seide K, et al. Is the wave plate still a salvage procedure for femoral non-union? Results of 75 cases treated with a locked wave plate. Eur J Trauma Emerg Surg, 2009, 35(2): 127-131.
23. Ricci WM, Ostrum RF. Orthopaedic knowledge update-Trauma 5. Rosemont: AAOS, 2016: 96-159.
24. Marti RK, Kloen P. Concepts and Cases in Nonunion Treatment. New York: Thieme, 2011: 560-649.
25. Bellabarba C, Ricci WM, Bolhofner BR. Results of indirect reduction and plating of femoral shaft non-unions after intramedullary nailing. J Orthop Trauma, 2001, 15(4): 254-263.
26. Abdel-Aa AM, Farouk OA, Elsayed A, et al. The use of a locked plate in the treatment of ununited femoral shaft fractures. J Trauma, 2004, 57(4): 832-836.
27. Murray WR, Lucas DB, Inman VT. Treatment of nonunion of fractures of the long bones by the two-plate method. J Bone Joint Surg (Am), 1964, 46-A(5): 1027-1048.
28. Matelic T, Monroe MT, Mast JW. The use of endosteal substitution in the treatment of recalcitrant non-unions of the femur: report of seven cases. J Orthop Trauma, 1996, 10(1): 1-6.
29. Maimaitiyiming A, Amat A, Rehei A, et al. Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients. Injury, 2015, 46(6): 1102-1107.
30. Ueng SW, Chao EK, Lee SS, et al. Augmentative plate fixation for the management of femoral nonunion after intramedullary nailing. J Trauma, 1997, 43(4): 640-644.
31. Ueng SW, Shih CH. Augmentative plate fixation for the management of femoral nonunion with broken interlocking nail. J Trauma, 1998, 45(4): 747-752.
32. Garnavos C. Treatment of aseptic non-union after intramedullary nailing without removal of the nail. Injury, 2017, 48 Suppl 1: S76-S81.
33. Park J, Kim SG, Yoon HK, et al. The treatment of nonisthmal femoral shaft non-unions with im nail exchange versus augmentation plating. J Orthop Trauma, 2010, 24(2): 89-94.
34. 茹江英, 仓海滨, 胡传亮, 等. 两种方法治疗股骨干骨折髓内钉固定后非感染性骨不连的疗效比较. 中国修复重建外科杂志, 2013, 27(1): 25-29.
35. Ru JY, Niu YF, Cong Y, et al. Exchanging reamed nailing versus augmentative compression plating with autogenous bone grafting for aseptic femoral shaft non-union: a retrospective cohort study. Acta Orthop Traumatol Turc, 2015, 49(6): 668-675.
36. Jiang LJ, Pan ZJ, Zheng Q. Augmentation plating in hypertrophic non-union after nail fixation of femoral shaft fracture compared with exchange plating. Chinese Medical Journal (Engl), 2014, 127(16): 2900-2905.
37. Wang Z, Liu C, Liu C, et al. Effectiveness of exchange nailing and augmentation plating for femoral shaft nonunion after nailing. Int Orthop, 2014, 38(11): 2343-2347.
38. Yang KH, Won Y, Kim SB, et al. Plate augmentation and autologous bone grafting after intramedullary nailing for challenging femoral bone defects: a technical note. Arch Orthop Trauma Surg, 2016, 136(10): 1381-1385.
39. Jordan CJ, Goldstein RY, McLaurin TM, et al. The evolution of the Ilizarov technique: part 1: the history of limb lengthening. Bull Hosp Jt Dis (2013), 2013, 71(1): 89-95.
40. Goldstein RY, Jordan CJ, McLaurin TM, et al. The evolution of the Ilizarov technique: part 2: the principles of distraction osteosynthesis. Bull Hosp Jt Dis, 2013, 71(1): 96-103.
41. Zhang Q, Zhang W, Zhang Z, et al. Femoral nonunion with segmental bone defect treated by distraction osteogenesis with monolateral external fixation. J Orthop Surg Res, 2017, 12(1): 183.
42. Zhang Q, Zhang W, Zhang Z, et al. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union. Injury, 2017, 48(10): 2270-2275.
43. Menon DK, Dougall TW, Pool RD, et al. Augmentative Ilizarov external fixation after failure of diaphyseal union with intramedullary nailing. J Orthop Trauma, 2002, 16(7): 491-497.
44. Brinker MR, O’Connor DP. Ilizarov compression over a nail for aseptic femoral nonunions that have failed exchange nailing: a report of five cases. J Orthop Trauma, 2003, 17(10): 668-676.
45. Azzam W, El-Sayed M. Ilizarov distraction osteogenesis over the preexisting nail for treatment of nonunited femurs with siginificant shortening. Eur J orthop Surg Traumatol, 2016, 26(3): 319-328.
46. Papakostidis C, Bhandari M, Giannoudis PV. Distraction osteogenesis in the treatment of long bone defects of the lower limbs: effectiveness, complications and clinical results; a systematic review and meta analysis. Bone Joint J, 2013, 95-B(12): 1673-1680.
47. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
48. Taylor BC, Hancock J, Zitzke R, et al. Treatment of bone loss with the induced membrane technique: techniques and outcomes. J Orthop Trauma, 2015, 29(12): 554-557.
49. Olesen UK, Eckardt H, Bosemark P, et al. The Masquelet technique of induced membrane for healing of bone defects. A review of 8 cases. Injury, 2015, 46 Suppl 8: S44-47.
50. Karger C, Kishi T, Schneider L, et al. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res, 2012, 98(1): 97-102.
51. Editorial. Treatment of bone defects: bone transport or the induced membrane technique? Injury, 2016, 47: 291-292.
52. Eom TW, Kim JJ, Oh HK, et al. Challenge to treat hypertrophic nonunion of the femoral shaft: the poller screw augmentation technique. Eur J Surg Traumatol, 2016, 26(6): 559-563.
53. Phemister DB. Treatment of ununited fractures by only bone grafts without screw or tie fixation and without breaking down of the fibrous union. J Bone Joint Surg (Am), 1947, 29(4): 946-960.
54. Chapman MW, Finkemeier CG. Treatment of supracondylar nonunion of the femur with plate fixation and bone graft. J Bone Joint Surg (Am), 1999, 81(9): 1217-1228.
55. Kim SJ, Shin SJ, Yang KH, et al. Endoscopic bone graft for delayed union and nonunion. Yonsei Med J, 2000, 41(1): 107-111.
56. Healey JH, Zimmerman PA, McDonnell JM, et al. Percutaneous bone marrow grafting of delayed union and nonunion in cancer patients. Clin Orthop Relat Res, 1990, (256): 280-285.
57. Matsuda Y, Sakayama K, Okumura H, et al. Percutaneous autologous bone marrow transplantation for nonunion of the femur. Nihon Geka Hokan, 1998, 67(1): 10-17.
58. Guimarães JA, Duarte ME, Fernandes MB, et al. The effect of autologous concentrated bone-marrow grafting on the healing of femoral shaft non-unions after locked intramedullary nailing. Injury, 2014, 45 Suppl 5: S7-S13.
59. Gross JB, Diligent J, Bensoussan D, et al. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases. Biomed Mater Eng, 2015, 25(1 Suppl): 187-197.
60. 付维力, 李祺, 李箭. 富血小板血浆在临床骨科中的应用进展. 中国修复重建外科杂志, 2014, 28(10): 1311-1316.
61. Malhotra A, Pelletier MH, Yu Y, et al. Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes. Arch Orthop Trauma Surg, 2013, 133(2): 153-165.
62. 高怡加, 陈柏行, 黄枫, 等. 富血小板血浆联合植骨治疗骨不连疗效的Meta分析. 中华关节外科杂志, 2017, 11(2): 171-175.
63. Peerbooms JC, Colaris JW, Hakkert AA, et al. No positive bone healing after using platelet rich plasma in a skeletal defect. An observational prospective cohort study. Int Orthop, 2012, 36(10): 2113-2119.
64. Tressler MA, Richards JE, Sofianos D, et al. Bone morphogenetic protein-2 compared to autologous iliac crest bone graft in the treatment of long bone nonunion. Orthopedics, 2011, 34(12): e877-884.
65. Takemoto R, Forman J, Taormina DP, et al. No advantage to rhBMP-2 in addition to autogenous graft for fracture nonunion. Orthopedics, 2014, 37(6): e525-530.
66. Friedlaender GE, Perry CR, Cole JD, et al. Osteogenic protein-1(bone morphogenetic protein-7) in the treatment of tibial nonunions. J Bone Joint Surg (Am), 2001, 83-A Suppl 1(Pt 2): S151-158.
67. Dimitriou R, Dahabreh Z, Katsoulis E, et al. Application of recombinant BMP-7 on persistent upper and lower limb non-unions. Injury, 2005, 36 Suppl 4: S51-59.
68. Zimmermann G, Moghaddam A, Wagner C, et al. Clinical experience with bone morphogenetic protein 7(BMP 7) in nonunions of long bones. Unfallchirurg, 2006, 109(7): 528-537.

Chinese Journal of Reparative and Reconstructive Surgery

Recent advances in treatment of aseptic femoral shaft nonunion

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