Abstract

During a ten-year period 37 femoral diaphyseal fractures were treated by a solitary AO (Arbeitsgemeinschaft füUr Osteosynthesefragen [Association for the Study of Problems of Internal Fixation]) plate. Thirty fractures united following the internal stabilization. The seven that received an autogenous cancellous bone graft with the plate united. Twenty nongrafted fractures that stabilized in the first week resulted in one nonunion and four delayed unions. Ten nongrafted fractures were stabilized more than one week following injury resulting in one delayed union and one nonunion. Two femurs united after the addition of a bone graft without disturbing the previously applied plate in the fifth month after initial stabilization. A new plate and bone graft produced union in the remaining five. Higher union rates have been reported with the intramedullary nail. A plate rather than an intramedullary nail is the preferred implant in fractures that are either comminuted or infraisthmal or in the presence of a femoral prosthetic stem.