Nonunion of distal femoral fractures: a systematic review

Nonunions of the distal femur are inherently difficult to treat and associated with significant patient disability. An extensive search of published reports was conducted and identified articles reviewed to determine the prevalence of various fracture patterns, initial treatment methods, reported risk factors, and definitive treatment methods. The definitive treatment modalities for distal femoral nonunions were then analyzed according to union rate, time to union and complications. The purpose of this review was to determine the risk factors that predispose to nonunion of the distal femur and the most effective treatment methods to implement after nonunion has occurred. The current review assesses 19 studies published over the last 12 years in which there were patients with nonunion of the distal femur and treatment specific to those patients was described. It was found that the most common fracture pattern involved metaphyseal comminution, most common initial treatment was open reduction and internal fixation with plating, most common reported risk factor was an open fracture, and most common definitive treatment was fixed angle plating combined with cancellous autografting. Taken together, the reviewed reports suggest that this form of treatment has a successful union rate of 97.4% and average time to heal of 7.8 months.