Exchange nailing versus augmentative plating in the treatment of femoral shaft nonunion after intramedullary nailing: a meta-analysis

With advances in the treatment of femoral shaft nonunion after intramedullary nailing, the optimal option remains controversial. This study aimed to quantitatively investigate outcomes in a comparison of exchange nailing and augmentative plating for femoral shaft nonunion after intramedullary nailing. The EMBASE, PubMed, Cochrane library and Clinical databases were systematically searched dating from their inception to March 2018. All retrospective controlled and prospective trials evaluating exchange nailing and augmentative plating for the treatment of femoral shaft nonunion after intramedullary nailing were identified. Two investigators extracted all related data independently and we used the review manager software to perform the meta-analysis. Three studies with a total of 232 patients were eligible for data extraction in our study. The meta-analysis indicated that the augmentative plating group had a lower nonunion rate, shorter time to union, less intra-operative blood loss, and shorter operative time than the exchange nailing group. While for the infection rate, there was no significant difference between augmentative plating and exchange nailing group. The available evidence has shown that augmentative plating is superior to exchange nailing for femoral shaft nonunion after intramedullary nailing.