Union rates of femur fractures deteriorate when the fracture is further distal than the isthmus
or is complicated with other risk factors like proximal third shaft fracture, HTN, DM, overweight
and obese, NSAIDs, smoking & alcohol consumption. All the treatment strategies, whether
exchange nailing or augmentative plating or open bone grafting which are presently employed,
have their own advantages as well as disadvantages. In order to overcome their individual
lacunae a combination modality approach may be helpful.