Background: Intramedullary nailing are used to treat femoral shaft fractures with an accepted success rate. However, non-union still reported and represented a challenge.
Aim of the work: The current work was designed to document the rate and time needed for union after bone augmented by plate with nail retention in treatment of femoral shaft non-unions with nailing. In addition to recognize potential complications related to the treatment approach, and to report on the overall clinical outcomes.
Patients and methods: This trial included 27 patients with non-union, who were scheduled for plate augmentation for bone grafting with nail retention. A standard preoperative assessment was performed [history taking, clinical examination, laboratory and radiological evaluation]. Then under spinal anesthesia, surgery was performed. Postoperative clinical and radiological evaluation was performed on regular intervals for at least 6 months. Radiological and clinical outcome was recorded and any complications were documented.    
Results: Data were collected for 27 patients [18 males and 9 females], their age ranged between 25 and 55 years.  Most of the patient [66.7%] had a history of motor accident. The mean time of nonunion was 9.33 ± 3.258. Hypertrophic nonunion was recorded for 22 patients [81.48%]. The mean operative time was 67.296 ± 10.571 minutes, with a range of 55-95 minutes. The mean blood loss was 200 ± 120.135 ml. Complete union was achieved in 26 patients [96.3%] with mean union time of months [5.111 ± 3.332]. On the basis of Wu's score, the outcome was excellent for 10 patients and good outcome was recorded for 16 patients.
Conclusion: Using plate augmentation in addition to the iliac bone graft seems to be a safe and effective treatment approach for non-united femoral shaft fracture in patients treated previously by the interlocking nails. It is associated with a high success [union] rate and reasonable clinical results.