{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T19:05:05Z","timestamp":1784574305587,"version":"3.55.0"},"reference-count":22,"publisher":"SLACK, Inc.","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Orthopedics"],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Objective:<\/jats:title>\n                    <jats:p>Locked intramedullary (IM) nails are the primary treatment modality for femoral shaft fractures. This study aimed to determine the risk of developing a femur nonunion as a function of nail-to-bone diameter mismatch.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>A retrospective case-control study was performed at a Level I trauma center. Adult patients with femoral shaft fractures (AO\/OTA 32 classification) treated with IM nail fixation from 2016 to 2022 were identified from the institutional database. Cases required nonunion surgery. Controls were randomly selected in a 3:1 ratio and included only if fractures healed at final follow-up based on the modified Radiographic Union Score of the femur (mRUSF). The primary outcome was nonunion. The study compared the association of nonunion with nail diameter (range, 9 mm to 13 mm) relative to femur width (range, 12 mm to 36 mm) and adjusted for smoking status, open fracture, and the degree of comminution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In total, 203 patients were included: 50 cases and 153 controls. Patients with a femur anterior-to-posterior diameter &gt;22 mm at the level of the lesser trochanter (11% of this sample) were at increased odds for nonunion when treated with a small diameter IM nail (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2\u20133.7;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .01). In patients with narrower femur diameters, the nail diameter was not associated with increased odds of nonunion surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Larger IM nails (\u226511 mm) might have protected against nonunion in patients with wide femoral canals (\u226522 mm) but likely conferred no significant benefit in patients with narrower femoral canals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3928\/01477447-20260429-02","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:47:42Z","timestamp":1779972462000},"source":"Crossref","is-referenced-by-count":0,"title":["Small Femoral Nails and the Development of a Nonunion: A Case-Control Study"],"prefix":"10.3928","volume":"49","author":[{"given":"Jordan","family":"Brand","sequence":"first","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan","family":"Hughes","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin E.","family":"Turner","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua E.","family":"Lawrence","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali","family":"Kovvur","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Gage","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Nascone","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus F.","family":"Sciadini","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan N.","family":"O'Hara","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2308","reference":[{"issue":"4","key":"e_1_3_1_2_2","first-page":"475","article-title":"The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia","volume":"14","author":"Costa P","year":"1988","unstructured":"Costa P, Carretti P, Giancecchi F, Pignedoli P, Rotini R, Tartaglia I. The locked Grosse-Kempf intramedullary nail in the treatment of diaphyseal and metaphyseal fractures of the femur and tibia. Ital J Orthop Traumatol. 1988;14(4):475\u2013482. PMID:3267682","journal-title":"Ital J Orthop Traumatol"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-198802000-00003"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198611000-00006"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-198701030-00003"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466040-00006"},{"issue":"12","key":"e_1_3_1_7_2","first-page":"568","article-title":"[Dynamic and static locking of the intramedullary nail]","volume":"75","author":"Klemm K","year":"1972","unstructured":"Klemm K, Schellmann WD. [Dynamic and static locking of the intramedullary nail]. Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed. 1972;75(12):568\u2013575. PMID:4265351","journal-title":"Monatsschr Unfallheilkd Versicher Versorg Verkehrsmed"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198567050-00005"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198466080-00010"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-198702010-00011"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001585"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000001670"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200701000-00006"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780050106"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-021-03134-6"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.5152\/j.aott.2021.20074"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002518"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02288864"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.medengphy.2003.10.006"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2004.03.014"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.5435\/00124635-200702000-00004"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.80B3.0800485"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199911000-00005"}],"container-title":["Orthopedics"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T18:48:59Z","timestamp":1784573339000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.healio.com\/doi\/10.3928\/01477447-20260429-02"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,1]]},"references-count":22,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5,1]]}},"alternative-id":["10.3928\/01477447-20260429-02"],"URL":"https:\/\/doi.org\/10.3928\/01477447-20260429-02","relation":{},"ISSN":["0147-7447","1938-2367"],"issn-type":[{"value":"0147-7447","type":"print"},{"value":"1938-2367","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,1]]}}}