Open interlocking nailing and bone grafting for neglected femoral shaft fractures.

PURPOSE To review the treatment outcome of patients with neglected femoral shaft fractures. METHODS Records of 22 men and 3 women aged 20 to 55 (mean, 36) years who underwent open interlocking nailing and bone grafting for neglected (2-month-old or more) closed femoral shaft fractures were reviewed. 21 had nonunion and 4 had malunion. All patients had deformed, shortened, and wasted lower limbs, with knee stiffness. The mean delay in presentation was 3 (range, 2-7) months. RESULTS Patients were followed up for a mean of 18 (range, 14-30) months. The mean time for radiological union was 5 (range, 4-7) months. Three patients had delayed union (6 months or more) and underwent secondary procedures (dynamisation or bone marrow injection). None had non-union. All had some degree of shortening; in 3 it was >2 cm. None had neurological injury following acute gain in length. None had deep infections; 2 had superficial wound infections and 6 had pin tract infections. Mean knee flexion improved 50 (from 70 to 120) degrees and the mean extensor lag decreased 7 (from 15 to 8) degrees. After a mean of 18 weeks, 23 of the patients were able to return to their work. CONCLUSION Open interlocking nailing and bone grafting coupled with aggressive rehabilitation can achieve acceptable results for patients with neglected femoral shaft fractures.