Summary
Evidence from nine case series suggests rates of solid union may be lower and the
complication frequency higher for exchange nailing of femoral shaft nonunions than
with plate fixation. However, no comparative study was found to evaluate the efficacy
and safety of these procedures and there were more series describing exchange nailing
than plate fixation. Methodologically rigorous comparative studies with larger populations
are necessary to establish the long term safety and efficacy of these two operative
treatments and to evaluate the superiority of one treatment over another.
