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Effect of Osteoperiosteal Decortication With Bone Grafting on Healing of Femoral Fracture Nonunion

Elgack MM, Sonbol AM, Kassab FN, Mohamed MAA, Yassin R, Shaheen E, Ali HSA

Case reports in orthopedics, 2026

Abstract

Femoral fractures are common injuries, typically demonstrating favorable outcomes with appropriate treatment. However, nonunion may occur due to several reasons. Osteoperiosteal decortication with bone grafting, initially described by Judet in 1969, has been recognized as a safe and effective method for managing nonunions. In this study, we aimed to determine the efficacy of this technique based on our experience in treating femoral nonunion. This case series included patients with femoral fracture nonunion who were treated with osteoperiosteal decortication performed by a single surgeon between April 2011 and January 2020. Data was collected from patients' medical records and hospital documents. The primary outcome measure was the attainment of clinical and radiographic unions during the follow-up period. The study included eight patients, including seven patients with diaphyseal fractures. Union was successfully achieved in all the patients. The mean time to union was approximately 6.13 ± 2 months. Five patients resumed full weight-bearing activities before 6 months. No additional procedures were required for any patient. In conclusion, osteoperiosteal decortication with bone grafting is an effective treatment approach for managing nonunions with promising success rates. The outcomes were satisfactory, as evaluated through clinical and radiological examinations.

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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.

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