Chipping and lengthening over nailing technique for femoral
shaft nonunion with shortening
Received: 2 February 2017 /Accepted: 5 June 2017 / Published online: 21 June 2017
SICOT aisbl 2017
Purpose Chipping and lengthening over nailing (CLON)
technique was developed to treat femoral shaft nonunion with
shortening more than 10 mm. The purpose of the current ret-
rospective case series was to clarify the effectiveness of the
CLON technique on the femoral shaft nonunion following
Methods Clinical and radiological outcomes in the patients
receiving operative treatment for femoral shaft nonunion be-
tween August 2012 and December 2016 were retrospectively
reviewed using the Refractory Fracture Data Registry at the
authors’ institution. The CLON technique was indicated for
patients with the femoral shaft nonunion with shortening more
than 10 mm.
Results Five patients with median follow-up of 32 months
(range, 14 to 50 months) were included in this study. All
patients achieved bone union at the median of 8 months after
the CLON technique. The median limb length discrepancy
was 2.0 mm at the most recent follow-up.
Conclusions The present study demonstrated that the CLON
technique for femoral shaft nonunion may be the first choice
as operative treatment for femoral shaft nonunion with short-
ening more than 10 mm.
Keywords Femoral shaft nonunion
Despite the current advancement of surgical technique and
devices, femoral shaft fracture sometimes fails to heal devel-
oping nonunion. Followed by the development of
intramedullary (IM) nailing technique for the femoral shaft
fractures, most can obtain solid bone union. Nevertheless, 3–
6% of patients ultimately result in femoral shaft nonunion
[1, 2]. Since femoral shaft nonunion causes serious socio-
economic problems for these patients [3, 4], various operative
techniques have been applied in order to obtain bone union.
However, there is no definite operative treatment established
to solve this problem.
To date, various operative techniques for femoral shaft
nonunion following IM nailing have been described, includ-
ing augmentative plating and exchanging IM nailing. In 2013,
a systematic review by Somford et al. found that the augmen-
tative plating resulted in a 96% union rates compared to 73%
in the exchanging nailing group . Nevertheless, the authors
indicated the obvious shortcoming of the augmentative plat-
ing; this technique did not allow correction of deformities with
the presence of IM nail .
The chipping and lengthening (CL) technique is an opera-
tive technique for long bone nonunion with deformities .
The CL technique involves the pulverization of both ends of
bone fragments and the application of Ilizarov external fixator
to correct the deformities. Its advantage over others is the
ability that mal-alignment of the affected limb can be reduced,
while the disadvantage is prolonged external fixation that po-
tentially increases the risk of pin-track infection and joint stiff-
ness . To avoid the disadvantage, the one-stage surgery;
Electronic supplementary material The online version of this article
(doi:10.1007/s00264-017-3535-x) contains supplementary material,
which is available to authorized users.
* Gen Sasaki
Department of Orthopaedic Surgery, Teikyo University School of
Medicine, 2-11-1, Kaga, Itabashi, Tokyo 173-8605, Japan
Fukushima Medical University, Fukushima, Japan
Southern TOHOKU General Hospital, Koriyama, Japan
International Orthopaedics (SICOT) (2017) 41:1859–1864