Femoral non-unions represent a formidable challenge for the orthopaedic surgeon. Their successful treatment is frequently time consuming, and requires utilisation of numerous resources. Three main methods of treatment have been described: intramedullary nailing (IMN), plating and external fixation. A systematic review of the existing English literature of femoral diaphyseal non-union treatment methods has been conducted. The gold standard remains exchange nailing despite the fact that plating has reached near equivocal rates of success. In cases where exchange nailing fails, the use of plates and external fixators has been shown to provide useful adjuncts to the nail. Most surgeons have preserved bone grafting as an option at a secondary or tertiary stage, after the initial revision procedure has failed.

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