TY  - JOUR
AU  - Tran, Duong Binh
AU  - Pham, Sinh The
AU  - Luong, Binh Xuan
AU  - Cao, Thi
PY  - 2026
DA  - 2026/05/26
TI  - Enhancing Bone Union in Aseptic Femoral Shaft Nonunion by Multimodal Autologous Bone Graft and Mechanical Stabilization
JO  - OBM Transplantation
SP  - 271
VL  - 10
IS  - 02
AB  - Aseptic femoral shaft nonunion represents a biologically compromised state in which impaired osteogenesis, insufficient vascularity, and inadequate mechanical stability prevent healing. Although mechanical revision is essential, achieving union often requires effective autologous bone tissue transplantation and biologic stimulation. This study evaluated a multimodal revision strategy integrating structural and cancellous autografts with mechanical reconstruction to restore both biological viability and stability at the nonunion site. Fifty-four patients with aseptic femoral shaft nonunion were retrospectively reviewed. Revision procedures included exchange nailing, augmentation plating with retained nail, plate replacement, or dynamization. All biologic strategies were based on autologous bone transplantation, including iliac crest cancellous bone grafting, cortical onlay strut grafts harvested from the iliac crest, and Judet osteoperiosteal decortication to enhance local vascularity. Union was assessed based on clinical and radiographic criteria during follow-up. The overall union rate was 96.3% (52/54). Hypertrophic and oligotrophic nonunions achieved 100% union, whereas atrophic nonunions achieved 83.3%. Both exchange nailing and augmentation plating resulted in 100% healing. The most favorable outcomes were observed in patients receiving combined autologous bone grafting (cancellous autograft ± cortical strut graft) together with Judet decortication, underscoring the importance of restoring osteogenic potential and biological activity in addition to mechanical rigidity. Multimodal revision combining stable fixation with autologous bone graft transplantation and biologic enhancement provides an effective treatment option for aseptic femoral shaft nonunion. These findings reinforce the principle that addressing biological insufficiency—through cancellous autografting, cortical strut transplantation, and decortication—is essential to achieving successful bone regeneration, particularly in atrophic nonunion.
SN  - 2577-5820
UR  - https://doi.org/10.21926/obm.transplant.2602271
DO  - 10.21926/obm.transplant.2602271
ID  - Tran2026
ER  -