An improved surgical technique to treat femoral shaft malunion: revised reamed intramedullary nailing technique.

Twenty-four consecutive adult patients who sustained a femoral shaft angular or rotational deformity, with or without significant shortening, were treated with skeletal traction of the femoral condyle, transverse femoral osteotomy, realignment of the shaft axis with or without lengthening, stable reamed intramedullary nail stabilization, and corticocancellous bone grafting. Twenty-one patients who underwent the treatment were followed-up for at least 1 year (range 1.0-4.5 years), and all achieved a solid union. The union rate was 100% (21/21) with a union period of 4.9+/-0.5 months. There were no significant complications. All patients achieved a satisfactory outcome as indicated by patient satisfaction and physician assessment of outcome (p < 0.001, Fisher's exact test). In the present series, the use of this revised reamed nailing technique resulted in a high success rate and a low complication rate. It provides an effective alternative treatment in indicated cases.