Osteosynthesis and Trauma Care 2004; 12(3): 130-134
DOI: 10.1055/s-2004-822800
Original Article

© Georg Thieme Verlag Stuttgart · New York

Use of an Expandable Nail in the Treatment of Non-Union Fractures of the Femur, Tibia and Humerus

M. Daccarett1 , B. M. Walz1 , D. Seligson1
  • 1Orthopaedics Trauma Fellow, University of Louisville, Louisville, KY, USA
Further Information

Publication History

Publication Date:
06 September 2004 (online)


Non-union after diaphyseal fractures is an important and relevant clinical problem. Despite the availability of improved surgical techniques, antibiotics, and complex soft tissue coverage procedures, non-union occurs in many patients after diaphyseal fractures [10] [20] [23] [36]. Twenty-four patients with the diagnosis of pseudarthrosis of femur, tibia, or humerus were operated on at the University of Louisville Hospital using an expandable intramedullary nail. The patients were followed until clinical and radiological union was achieved. Twenty-three of the twenty-four patients obtained satisfactory results with this method of fixation. This preliminary study demonstrates that an expandable intramedullary nail can be used successfully in the treatment of selected long bone pseudarthrosis.


  • 1 Baker S P, O'Neill B, Haddon W, Long W B. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.  J Trauma. 1974;  14 187-196
  • 2 Bhandari M, Guyatt G H, Swiontkowski M F, Scemitsch E H. Treatment of open fractures of the shaft of the tibia.  J Bone Joint Surg [Br]. 2000;  82 62-68
  • 3 Bono C M, Levine R G, Rao J P, Behrens F F. Nonarticular proximal tibia fractures: treatment options and decision making.  J Am Acad Orthop Surg. 2001;  9 176-186
  • 4 Boyer M I, Ribeiro E, Hu R, Powell I N. Small versus large diameter closed-section femoral nails for the treatment of femoral shaft fractures: is there a difference?.  J Trauma. 1996;  41 279-282
  • 5 Brighton C T, Pollack S R. Treatment of recalcitrant non-union with a capacitively coupled electrical field: A preliminary report.  J Bone Joint Surg [Am]. 1985;  67 577-585
  • 6 Campbell's Operative Orthopaedics. Text Book. 10th edition. Vol. 4. Elsevier Science 2002
  • 7 Capelli R M, Galmarini V, Molinari G P, De Amicis A. The Fixion expansion nail in the surgical treatment of diaphyseal fractures of the humerus and tibia. Our experience.  Vhir Organi. 2003;  LXXXVIII 57-64
  • 8 Chapman M W. The effect of reamed and nonreamed intramedullary nailing on fracture healing.  Clin Orthop. 1998;  355 (Suppl) S230-S238
  • 9 Clatworthy M G, Clark D I, Gray D H, Hardy A E. Reamed versus unreamed femoral nails. A randomised, prospective trial.  J Bone Joint Surg [Br]. 1998;  80 485-489
  • 10 Gustilo R B, Mendoza R M, Williams D N. Problems in the management of type III (severe) open fractures: A new classification of type III open fractures.  J Trauma. 1984;  24 742-746
  • 11 Hammacher E R, van Meeteren M C, van der Werken C. Improved results in treatment of femoral shaft fractures with the unreamed femoral nail? A multicenter experience.  J Trauma. 1998;  45 517-521
  • 12 Helfet D L, Jupiter J B, Gasser S. Indirect reduction and tension-band plating of tibial non-union with deformity.  J Bone Joint Surg [Am]. 1992;  74 1286-1297
  • 13 Herscovici D, Ricci W M, McAndrews P, DiPasquale T, Sanders R. Treatment of femoral shaft fracture using unreamed interlocked nails.  J Orthop Trauma. 2000;  14 10-14
  • 14 Johnson K D. Management of malunion and nonunion of the tibia.  Orthop Clin North Am. 1987;  18 157-171
  • 15 Kessler S B, Hallfeldt K K, Perren S M, Schweiberer L. The effects of reaming and intramedullary nailing on fracture healing.  Clin Orthop. 1986;  212 18-25
  • 16 Lepore L, Lepore S, Maffulli N. Intramedullary nailing of the femur with an inflatable self-locking nail: Comparison with locked nailing.  J Orthop Sci. 2003;  8 796-801
  • 17 Marsh J, Nepola J, Seabold J. Subclinical infection in delayed nonunion of fractures [abstract].  J Orthop Trauma. 1989;  3 169
  • 18 Mayo K A, Benirschke S K. Treatment of tibial malunions and nonunions with reamed intramedullary nails.  Orthop Clin North Am. 1990;  21 715-724
  • 19 Merkel K D, Brown M L, Dewanjee M K. et al . Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis: A prospective study.  J Bone Joint Surg [Am]. 1985;  67 465-476 J Bone Joint Surg [Br]. 1990;  72 347-355
  • 20 Nelson F RT, Brighton C T, Ryaby J, Simon B J, Nielson J H, Lorich D J, Bolander M, Seelig J. Use of physical forces in bone healing.  J Am Acad Orthop Surg. 2003;  11 344-354
  • 21 Nowotarski P J, Turen C H, Brumback R J, Scarboro J M. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients.  J Bone Joint Surg [Am]. 2000;  82 781-788
  • 22 Pape H C, Bartels M, Pohlemann T, Werner T, von Glinski S, Baur H, Tscherne H. Coagulatory response after femoral instrumentation after severe trauma in sheep.  J Trauma. 1998;  45 720-728
  • 23 Pugh D MW, McKee M D. Advances in the management of humeral nonunion.  J Am Acad Orthop Surg. 2003;  11 48-59
  • 24 Riemer B L, Butterfield S L. Comparison of reamed and nonreamed solid core nailing of the tibial diaphysis after external fixation: A preliminary report.  J Orthop Trauma. 1993;  7 279-285
  • 25 Rockwood, . Green and Wilkins' Fractures. Text Book. 5th edition. Lippincott Williams & Wilkins 2001
  • 26 Schmidt A H, Finkemeier C O, Tornetta P. Treatment of closed tibial fractures.  J Bone Joint Surg [Am]. 2003;  85 352-368
  • 27 Schwartsman V, Choi S H, Schwartsman R. Tibial nonunions: Treatment tactics with the Ilizarov method.  Orthop Clin North Am. 1990;  21 639-653
  • 28 Scott G, King J B. A prospective, double blind trial of electrical capacitive coupling in the treatment of non-union of long bones.  J Bone Joint Surg [Am]. 1994;  76 820-826
  • 29 Simpson J M, Ebraheim N A, An H S. et al . Posterolateral bone graft of the tibia.  Clin Orthop. 1990;  251 200-206
  • 30 Sledge S L, Johnson K D, Henley M B. et al . Intramedullary nailing with reaming to treat non-union of the tibia.  J Bone Joint Surg [Am]. 1989;  71 1004-1019
  • 31 Smith M A, Jones E A, Strachan R K. et al . Prediction of fracture healing in the tibia by quantitative radionuclide imaging.  J Bone Joint Surg [Br]. 1987;  69 441-447
  • 32 Smith W R, Ziran B H, Morgan S J. et al .Expandable intramedullary nailing for long bone fractures: Analysis of results and complications. Disc Orthopaedic Technologies Inc 2002
  • 33 Tornetta P, Tiburzi D. Reamed versus nonreamed anterograde femoral nailing.  J Orthop Trauma. 2000;  14 15-19
  • 34 Tornetta P, Tiburzi D. The treatment of femoral shaft fractures using intramedullary interlocked nails with and without intramedullary reaming: a preliminary report.  J Orthop Trauma. 1997;  11 89-92
  • 35 Wang J-W, Weng L-H. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting.  J Bone Joint Surg [Am]. 2003;  85 436-440
  • 36 Wiss D A, Johnson D L, Miao M. Compression plating for non-union after failed external fixation of open tibial fractures.  J Bone Joint Surg [Am]. 1992;  74 1279-1285
  • 37 Wiss D A, Stetson W B. Nonunion of the tibia treated with a reamed intramedullary nail.  J Orthop Trauma. 1994;  8 189-194
  • 38 Wiss D A, Stetson W B. Tibial nonunion: Treatment alternatives.  J Am Acad Orthop Surg. 1996;  4 249-257
  • 39 Wolinsky P, Tejwani N, Richmond J H, Koval K J, Egol K, Stephen D JG. Controversies in intramedullary nailing of femoral shaft fractures.  J Bone Joint Surg [Am]. 2001;  83 1404-1415

Miguel Daccarett MD 

Orthopaedics Trauma Fellow · University of Louisville

Louisville, KY 40202


Email: msdaccarett@hotmail.com