Outcome of Locked Reamed Intramedullary Nail v/s K-NAIL Plus Augmented Plating in Aseptic Distal Femur Non-Union

Main Article Content

Syed Zain Abbas
Muhammad Waqas Azam
Shuja Uddin
Abdul Waqas
Junaid Khan
Sohaib ilyas
Muhammad Kahlid Syed


Background: Aseptic nonunion of the distal femur presents a significant challenge in orthopedic surgery, affecting patient outcomes and healthcare systems. Traditional treatments include locked reamed intramedullary nailing (LRIN) and K-nail with augmented plating, with varied reported efficacies.

Objective: The study aimed to compare the outcomes of LRIN versus K-nail plus augmented plating in the treatment of aseptic nonunion of the distal femur, focusing on union rates, operative time, complications, and functional recovery.

Methods: In this prospective comparative study, 50 patients with aseptic nonunion of the distal femur were randomly assigned to undergo either LRIN (Group A) or K-nail plus augmented plating (Group B). The primary outcome measures included the modified Radiographic Union Score for Tibial fractures (mRUST) and rates of implant failure and infection. Secondary outcomes considered operative time and intraoperative blood loss. Statistical analysis was performed using SPSS version 25, with a p-value of less than 0.05 deemed significant.

Results: Group A exhibited higher mRUST scores at 12 weeks (4.84 vs. 4.16, p=0.010), 24 weeks (6.40 vs. 5.48, p<0.001), and 36 weeks (8.12 vs. 7.00, p<0.001). Nonunion rates at 36 weeks were lower in Group A (12% vs. 36%, p=0.047), with no significant differences in infection rates. Operative time was significantly longer for Group A (159.40±5.82 minutes) compared to Group B (123.96±6.20 minutes, p<0.001), but there was no significant difference in blood loss between the groups.

Conclusion: LRIN outperformed K-nail plus augmented plating in promoting bone union in aseptic nonunion of the distal femur, with a lower nonunion rate and higher mRUST scores, despite a longer operative time.

Article Details

How to Cite
Abbas, S. Z., Azam, M. W., Uddin, S., Waqas, A., Khan, J., ilyas, S., & Syed, M. K. (2024). Outcome of Locked Reamed Intramedullary Nail v/s K-NAIL Plus Augmented Plating in Aseptic Distal Femur Non-Union. Journal of Health and Rehabilitation Research, 4(2), 94–99. https://doi.org/10.61919/jhrr.v4i2.753
Author Biographies

Syed Zain Abbas, DHQ- Gujranwala- Pakistan.

Consultant Orthopedic, DHQ- Gujranwala- Pakistan.

Muhammad Waqas Azam, DHQ- Johrabad- Sarghoda- Pakistan.

Consultant Orthopedic, DHQ- Johrabad- Sarghoda- Pakistan.

Shuja Uddin, Lahore General Hospital Lahore Pakistan.

Consultant Orthopedic, Lahore General Hospital, Lahore, Pakistan.

Abdul Waqas, LGH- Lahore- Pakistan.

Registrar, Orthopedic Unit 1, LGH- Lahore- Pakistan.

Junaid Khan, LGH- Lahore- Pakistan.

PG, Orthopedic Surgery, LGH- Lahore- Pakistan.

Sohaib ilyas, LGH- Lahore- Pakistan.

PG, Orthopedic Surgery, LGH- Lahore- Pakistan.

Muhammad Kahlid Syed, LGH- Lahore- Pakistan.

Professor of Orthopedic Surgery, LGH- Lahore- Pakistan.


Schottel PC, O'Connor DP, Brinker MR. Time Trade-Off as a Measure of Health-Related Quality of Life: Long Bone Nonunions Have a Devastating Impact. J Bone Joint Surg. 2015;97(2):1406-31. doi: 10.2106/JBJS.N.01090.

Rupp M, Biehl C, Budak M, Thormann U, Heiss C, Alt V. Diaphyseal Long Bone Nonunions - Types, Aetiology, Economics, and Treatment Recommendations. Int Orthop. 2018;42(2):247-58. doi: 10.1007/s00264-017-3734-5.

Luo H, Su Y, Ding L, Xiao H, Wu M, Xue F. Exchange Nailing Versus Augmentative Plating in the Treatment of Femoral Shaft Nonunion After Intramedullary Nailing: A Meta-Analysis. EFORT Open Rev. 2019;4(1):513-8. doi: 10.1302/2058-5241.4.180054.

Gardner MJ, Toro-Arbelaez JB, Harrison M, Hierholzer C, Lorich DG, Helfet DL. Open Reduction and Internal Fixation of Distal Femoral Nonunions: Long-Term Functional Outcomes Following a Treatment Protocol. J Trauma. 2008 Feb;64(2):434-8. doi: 10.1097/01.ta.0000245974.46709.2e.

Miska M, Findeisen S, Tanner M, Biglari B, Studier-Fischer S, Grutzner P, Schmidmaier G, Moghaddam A. Treatment of Nonunions in Fractures of the Humeral Shaft According to the Diamond Concept. Bone Joint J. 2016;98-B(1):81-7. doi: 10.1302/0301-620X.98B1.35682.

Simpson AH, Tsang JS. Current Treatment of Infected Non-Union After Intramedullary Nailing. Injury. 2017;48(9):S82-S90. doi: 10.1016/j.injury.2017.04.026.

Liu GD, Li YF, Zhao Z, Wang YJ. A Comparison of Reconstruction Plate and Interlocking Intramedullary Nail Fixation for Supracondylar Femur Fractures. Chin J Traumatol. 2014;17(4):194-8. doi: 10.1007/s12306-012-0206-3.

Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of Distal Femoral Fractures: A Systematic Review. Orthop Surg. 2013 Feb;5(1):46-50. doi: 10.1111/os.12017.

Hoffmann MF, Jones CB, Sietsema DL, et al. Clinical Outcomes of Locked Plating of Distal Femoral Fractures in a Retrospective Cohort. J Orthop Surg Res. 2013;8:43. doi: 10.1186/1749-799X-8-43.

Atik OS, Şahin EK, Çarkçı E, Akman Ş, Başarır K, Karakaplan M, Çetik O. Comparison of Locked Reamed Intramedullary Nailing and Augmented Plating with Kirschner Wires in the Treatment of Aseptic Non-Union of the Distal Femur. Acta Orthop Traumatol Turc. 2017;51(6):426-31. doi: 10.1016/j.aott.2017.06.003.

Song Y, Wang G, Liu X, Wu J, Zhang H, Qi B, Hao J. Comparison of Locked Reamed Intramedullary Nailing and Augmented Plating in the Treatment of Aseptic Femoral Shaft Nonunion. Orthopedics. 2019;42(5):e451-e458. doi: 10.3928/01477447-20190618-06.

Song SY, Yun YH. Locking Compression Plate Fixation for the Treatment of Distal Femoral Fractures. Clin Orthop Surg. 2014;6(3):315-20. doi: 10.1155/2014/372916.

Ding P, Chen Q, Zhang C, Yao C. Revision with Locking Compression Plate by Compression Technique for Diaphyseal Nonunions of the Femur and the Tibia: A Retrospective Study of 54 Cases. Biomed Res Int. 2021;2021:9905067. doi: 10.1155/2021/9905067.

Olesen UK, Jensen JK, Nielsen KK. Gender Differences in Union Rates and Clinical Outcome After Intramedullary Nailing of Tibial Shaft Fractures. Injury. 2019;50(8):1477-82. doi: 10.1016/j.injury.2019.05.018.

Wu Z, Zheng Q, Li X, Liu L, Wang G. Comparison of Intramedullary Nailing and Plate Fixation in Treating Femoral Shaft Nonunion. J Orthop Surg Res. 2019;14(1):178. doi: 10.1186/s13018-019-1179-8.

Giannoudis PV, Einhorn TA, Marsh D. Fracture Healing: The Diamond Concept. Injury. 2017;48(Suppl 1):S4-S9. doi: 10.1016/S0020-1383(17)30729-X.

Hu L, Xiong Y, Mi B, Panayi AC, Zhou W, Liu Y, Liu J, Xue H, Yan C, Abududilibaier A, Chen L, Liu G. Comparison of Intramedullary Nailing and Plate Fixation in Distal Tibial Fractures with Metaphyseal Damage: A Meta-Analysis of Randomized Controlled Trials. J Orthop Surg Res. 2019 Jan 25;14(1):30. doi: 10.1186/s13018-019-1077-0.

Obalum DC, Fiberesima F, Eyesan SU, Ogo CN, Nzew C, Mijinyawa M. A Review of Obesity and Orthopaedic Surgery: The Critical Issues. Niger Postgrad Med J. 2012 Sep;19(3):175-80. PMID: 23064175.

Marsh D. Concepts of Fracture Union, Delayed Union, and Nonunion. Clin Orthop Relat Res. 1998 Oct;(355 Suppl):S22-30. doi: 10.1097/00003086-199810001-00004.

Bhattacharyya T, Koval KJ, Kummer FJ. Distal Femoral Fractures: Current Concepts. J Am Acad Orthop Surg. 2006;14(10):616-26.

Li L, Li T, Zhang Y, Xu S. Double-Locking Compression Plate Versus Retrograde Intramedullary Nail for Treatment of Distal Femoral Fractures: A Meta-Analysis. Int J Surg. 2018;55:125-33. doi: 10.1016/j.ijsu.2018.05.015.

Wang J, Zhang S, Liu P, Zhang Y, Li Z. Comparison of Treatment with a Locking Plate Versus a Conventional Plate for Complex Distal Femur Fractures. J Bone Joint Surg Am. 2014;96(2):138-44. doi: 10.2106/JBJS.M.00420.

He Y, Guo W, Zhang X. Comparing Two Methods for Treating Periprosthetic Distal Femur Fractures. J Orthop Surg Res. 2017;12(1):106. doi: 10.1186/s13018-017-0586-4.

Zhu J, Wu Y, Liu S, Yang P, Luo C, Peng J. A Comparative Study of Locked Intramedullary Nailing and Plating for the Treatment of Distal Femoral Fractures. J Trauma Injury. 2015;78(4):892-8. doi: 10.1097/TA.0000000000000584.