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Questions About Treating a Non-Union Femur Fracture
[Femur is non-union at nine months. I have 1.5 votes for a rerod, one vote for bone grafting, and one patient who is tired of holes and full of questions.]

My gut impression, looking back on week three's x-rays, is that this leg never had a chance on a cellular level. What have you all (four orthopaedists) been quietly hoping was going to happen?

I read once that dynamization only works in 50% of the cases? Anybody know why? Are there any interesting attributes of the cases where it works or does not work. And when is the latest week it has succeeded? (We sort of did this when the screw broke, but have nto revisited the idea.)

How will rerodding help? For the sake of discussion, I will work with a repeat of a 12.5 mm ream, and a 12 mm nail. The actual numbers may vary, but the question does not. I understand how you will leave a slurry around the nail that can turn into contiguous bone. That would give a tube of bone around the nail. How does that help turn the tube of fiber around that tube of bone into bone?

Why is bone grafting better than rerodding the femur? That seems like a lot more holes, for the same wild chance that something might take. (And I did see an abstract of a study, 105 non-unions, 101 followed, 96 healed after first rerod, remaining five healed after second. Any thoughts?)

How many holes do you put in a patient for a bone graft? Are they needle holes or big slices? (My muscles are getting tired of these insults.)

Why would a bone graft work? I'm looking for cellular behavior here. Is it because BMUs only travel 2.5 mm and if they don't hit more bone, they give up? This goes back to, "Why isn't it healing now, and how is another intrusion going to change that?"

Gut reaction: To invoke Wolffe's Law, how about a new nail, and no distal screw?