194 Abstract [O94] Uncemented revision in B2, B3 post-operative femoral fractures—–The role justified? F. Rayan ∗ , S. Konangaparambath, F.S. Haddad University College London Hospitals, United Kingdom Periprosthetic femoral fracture is a recognised complica- tion of total hip arthroplasty. The desired outcome of their treatment is patient’s return to pre-morbid daily activi- ties. This can be challenging and may have to be tailored to individual patients, harmonizing various factors such as co-morbid health status of the patient, the surgeon’s exper- tise, availability of resources and the fracture personality. The Vancouver classification imparts a simple and repro- ducible system to segregate the peri-prosthetic fractures of the femur following a total hip arthroplasty. It links the fracture to management options. The type B subgroup in the Vancouver system are probably the most crucial as they involve the bone in the vicinity of the femoral stem. Fracture of the femur in the presence of an unstable prosthesis (Vancouver sub type B2 and B3), often makes sur- gical treatment imperative. In this retrospective cohort we describe our experience with the management of 26 patients who sustained peri-prosthetic fractures of the Vancouver sub type B2 or B3, between 1999 and 2005. All patients were managed by revision arthroplasty, using cementless femoral stem (14 Echelon, 7 Link, 2 Cannulok, 2 ZMR, 1 Custom prosthesis). Cortical struts, cable plating sys- tem, bone allograft and demineralised bone matrix were used to aid reconstruction where indicated. Good recov- ery was noted in all cases. All fractures healed clinically and radiologically. The outcome was subjectively graded as satisfactory by all patients and this is substantiated objec- tively, by a post-operative mean Harris hip score of 86 (range 75—90). No major complications were noted in this series. Keywords: Uncemented; Peri-prosthetic; Femur; Revision doi:10.1016/j.injury.2007.11.384 [O95] The outcome of intramedullary nailing for pathological lesions of the femur L. Tiessen ∗ , A. Metcalfe, S. Jones University Hospital of Wales Cardiff, UK Introduction: Pathological lesions of the femur are a chal- lenge for the treating team. We endeavour to evaluate our experience. Methods: This study is a consecutive case series of 84 patients who between March 1999 and May 2006 underwent intramedullary nailing of pathological femoral lesions. Eight (9.5%) of the 87 secondary pathological lesions of the femur underwent prophylactic fixation. Three patients had staged bilateral procedures. Along with primary diagnosis and disease extent the fix- ation device, use of cement augmentation and radiological together with clinical outcome were considered. Results: The mean patient age was 69 years (range 36—92). The primary tumours were breast (30%), prostate (21%), multiple myeloma (12%), renal (7%), lung (7%), mis- cellaneous (14%) and unknown primary (9%). The lesions were located in the proximal femoral metaphysis in 74% of the cases, the diaphysis in 13% and in the distal metaphysis in 8%. The entire femur was involved in 3% of the cohort. The majority of patients received a cephalo-medullary nail 71 (81.6%), 11 patients (12.6%) received an antegrade nail and 5 (5.7%) were treated with a retrograde nail. The mean follow-up of the surviving patients group is currently 16.7 months (range 0.5—35 months). The mean survival of the patients who had died at time of study was 6.6 months (range 1 day to 46 months). No implant failures have been observed. Two patients have required re-operation to date: one due to distal metaphyseal disease progression causing a femoral condyle fracture and one patient required a revision of the antegrade nail due to proximal migration. Discussion: Intramedullary fixation provides reliable results in this challenging patient group and continues to be the primary mode of treatment for pathological deposits throughout the femur. Keywords: Pathological lesions; Femur; Intramedullary nail- ing doi:10.1016/j.injury.2007.11.385 [O96] Assessment of success and factors resulting in the failure of exchange nailing in the treatment of non-union of the femoral shaft fractures A. Mofidi 1,∗ , N. Maripuri 1,2 , L. Tiessen 1,2 , K. Mohanty 1,2 , I. Pallister 1 1 Morriston Hospital Swansea, UK 2 University Hospital of Wales Cardiff, UK Abstract: Exchange nailing has been advocated as a method for the treatment of femoral non-union. The femoral nail stabilizes the fracture, and inability of the fracture to unite does not have a great impact on patient’s mobility or symp- toms till the implant fails by fatigue. However, the reported success of exchange nailing in the treatment of femoral non-union has been variable ranging from 50 to 100%. The aim of this study was to analyze the factors which are associated with failure of exchange nailing for femoral non- union. Twenty-nine patients (30 femora) with average age of 42 ± 20 years who had undergone exchange nailing for aseptic femoral non-union between 2000 and 2006 were identified and reviewed. The average time from injury to exchange nailing was 14 ± 10 months. Twenty-two of the cases were atrophic non-union and the rest were hyper- trophic non-union. There were four cases of nail failure and seven patients had an allied procedure to aid union at the time of exchange femoral nailing. Success rate of this procedure to achieve ultimate union was 76% after one operation and 93% after two operations. We found a direct relationship between smoking p < 0.05, a difference between the original and exchanged nail diameter p < 0.05 and a correct biomechanical rationale for exchange nailing p < 0.03 with the speed of union after exchange nailing. How- ever comminution, allied procedures, injury severity score and age were not associated with the speed of union after