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Related Experiment Video

Updated: Jul 2, 2026

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Radiographic Union Assessment in Surgically Treated Distal Femur Fractures: A Systematic Review.

Alice Wei Ting Wang1, David J Stockton1,2, Andreas Flury1

  • 1Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

JBJS Reviews
|March 6, 2024
PubMed
Summary

Distal femur fracture healing lacks a standard radiographic definition, hindering optimal surgical treatment. Future research needs validated measures of bone healing and functional outcomes for improved patient care.

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Area of Science:

  • Orthopedic Surgery
  • Radiology
  • Biomedical Engineering

Background:

  • Distal femur fractures present high nonunion rates, with no consensus on optimal treatment or radiographic union criteria.
  • Inconsistent fracture healing measures limit generalizability and comparison across studies.
  • This review identifies current radiographic definitions of union for surgically treated distal femur fractures.

Approach:

  • Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
  • Searched Medline, EMBASE, Cochrane, and Web of Science databases from inception to October 2022.
  • Included studies on surgically treated distal femur fractures with radiographic union assessment.

Key Points:

  • Sixty articles involving 3,050 fractures were analyzed, with lateral locked plates being the most common intervention.
  • Common union definitions included "bridging or callus formation across 3 of 4 cortices" (43%) and "bony bridging of cortices" (35%).
  • Mean union rate was 89% (range 58%-100%), with a mean time to union of 18 weeks; no studies correlated radiographic union with functional outcomes.

Conclusions:

  • Current literature lacks a consistent definition for radiographic union in distal femur fractures, and the optimal time for assessment remains unclear.
  • Validated, reliable measures of radiographic bone healing are needed.
  • Future research should correlate radiographic findings with functional outcomes to advance surgical optimization.