Fifty-seven patients with aseptic femoral shaft nonunion following intramedullary nailing were randomized to receive either exchange nailing (n=29) or augmentative plating with autologous bone grafting (n=28). The primary outcome of interest was time to bone union and union rate at 12 months post-revision surgery. Secondary outcomes included operative time, blood loss, hospitalization duration, pain level (VAS), knee range of motion (ROM), and complication rates. Outcomes were assessed over a 12-month follow-up period. Overall, the results of the study revealed that augmentative plating led to a significantly shorter mean time to union, higher union rates, reduced pain, and fewer complications (3.57% vs. 17.24%). These findings suggest that augmentative plating is superior to exchange nailing for improving healing, function, and safety in patients with femoral shaft nonunion.