The causes of nonunion of the femur shaft could be divided as fracture itself and iatrogenic. And also the methods of treatment are controversial. From Dec. 1988 to Jan. 1995. We analyzed 21 cases of nonunion of the femur shaft. The period of follow up was from 1 year to 4 year 7 month (average time 2 years). The causes of the nonunion were fracture itself in 1 case, inadequate fixation in 17 cases, and early weight bearing in 3 cases. Seventeen of 21 were plate fixation cases and 4 or 21 were intramedullary-nailing cases. Metallic failures were seen in 15 cases.

Cancellous bone graft was done in all cases. Cancellous bone graft only without other additional fixation were done in two cases, plate fixation were done in 8 cases, and intramedullary nailing were done in 11 cases. Additional narrow plate fixations were done in 9 cases, which 3 cases were done with plate fixation and 6 cases were done with intramedullary nailing. Partial weight bearing were done 2.5 months in which case cancellous bone graft only, plate fixation and intramedullary nailing cases, were done 2 months in the case of narrow additional plate with intramedullary nailing.

Authors concluded that stable internal fixation was very important and additional narrow plate fixation was good alternative method in the treatment of nonunion of the femur shaft.