Nonunion of the femoral diaphysisTHE INFLUENCE OF REAMING AND NON-STEROIDAL ANTI-INFLAMMATORY DRUGSP. V. Giannoudis, MD, Senior Registrar; D. A. MacDonald, FRCS, Consultant Orthopaedic Surgeon; S. J. Matthews, FRCS, Consultant Orthopaedic Surgeon; and R. M. Smith, MD, FRCS, Consultant Orthopaedic SurgeonDepartment of Orthopaedics and Trauma, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK. A. J. Furlong, FRCS, Senior Registrar; and P. De Boer, FRCS, Consultant Orthopaedic Surgeon Department of Orthopaedics and Trauma, York District Hospital, Wiggington Road, York YO3 7HE, UK. Correspondence should be sent to Mr R. M. Smith. We assessed factors which may affect union in 32 patients with nonunion of a fracture of the diaphysis of the femur and 67 comparable patients whose fracture had united. These included gender, age, smoking habit, the use of non-steroidal anti-inflammatory drugs (NSAIDs) the type of fracture (AO classification), soft-tissue injury (open or closed), the type of nail, the mode of locking, reaming v non-reaming, infection, failure of the implant, distraction at the fracture site, and the time to full weight-bearing. Patients with severe head injuries were excluded. Both groups were comparable with regard to gender, Injury Severity Score and soft-tissue injury. There was no relationship between the rate of union and the type of implant, mode of locking, reaming, distraction or smoking. There were fewer cases of nonunion in more comminuted fractures (type C) and in patients who were able to bear weight early. There was a marked association between nonunion and the use of NSAIDs after injury (p = 0.000001) and delayed healing was noted in patients who took NSAIDs and whose fractures had united. This article has been cited by other articles:
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