Distal femoral nonunion treated with interlocking nailing

From December 1986 to September 1989, 24 consecutive cases of distal femoral nonunion in adults were treated with Grosse-Kempf interlocking nailing and prospectively followed for an average of 32 months. The union rate was 91.7% (22/24) with a union period of 4.5 +/- 1.8 months. Complications occurred in two patients (8.3%), who suffered nonunion because of implant failure. A cast brace is very useful in promoting ambulation and reducing early overactivity. The potential for implant failure is a result of a concentration of stress over the nail hole, with the most stress occurring near the fracture site (p less than 0.05).