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Risk Factors for Development of a Recalcitrant Femoral Nonunion: A Single Surgeon Experience in 122 Patients
Donald A Wiss1,2, John Garlich1, Sohaib Hashmi1
1Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA; and.
Journal of Orthopaedic Trauma
|October 1, 2021
Summary
Most femoral nonunions heal, but a significant portion require further treatment or fail to unite. Deep infection, smoking, metabolic bone disease, and multiple prior surgeries predict recalcitrant femoral nonunions.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Bone Healing Research
Background:
- Femoral nonunions represent a significant challenge in orthopedic trauma.
- Understanding healing rates and risk factors is crucial for optimizing patient outcomes.
Purpose of the Study:
- To document healing rates of femoral nonunions.
- To determine the prevalence of recalcitrant femoral nonunions.
- To identify risk factors associated with recalcitrant femoral nonunions.
Main Methods:
- Longitudinal observational cohort study.
- Analysis of 122 femoral nonunions treated with plates or intramedullary nails.
- Bivariate and multivariate regression analyses to identify risk factors.
Main Results:
- 83.6% of femoral nonunions eventually healed, with 66% healing as intended.
- 17.2% required additional procedures, and 16.4% failed to unite.
- Deep infection, current smoking, metabolic bone disease, and >=3 prior surgeries predicted recalcitrance.
Conclusions:
- Both intramedullary nails and modern plates showed high recalcitrance rates.
- Infection, smoking, metabolic bone disease, and multiple prior surgeries are key predictors of recalcitrant femoral nonunions.
