Summary
Age, gender, fracture type, nail locking technique, and bone grafting did not appear
to affect union, mean time to union, or need for additional procedures. Evidence on
smoking as a prognostic factor was conflicting. Nonsmokers were more likely to achieve
union after one procedure compared with smokers in one study. However, the mean time
to union and need for additional procedures were not decreased in nonsmokers in two
other studies. Studies may have had insufficient power to detect the effects of various
prognostic factors. A methodologically rigorous multi-center prognostic study may
provide a larger sample size, and help delineate factors affecting outcome in exchange
nailing for the treatment of femoral shaft nonunion.
