Risk Factors for Nonunion After Femoral Rotational Osteotomy for Idiopathic Anteversion and Retroversion in...

Area of Science:

• Orthopedic surgery
• Pediatric orthopedics

Background:

• Lower extremity rotational abnormalities impact ambulation, cause pain, and affect self-image in children and adolescents.
• Femoral rotational osteotomies correct these issues, improving function and well-being.
• Risk factors for nonunion after these procedures in pediatric patients are not well-established.

Purpose of the Study:

• To identify risk factors for nonunion following femoral rotational osteotomies in adolescents.
• To provide data for risk stratification and patient counseling.

Main Methods:

• Retrospective review of 10- to 18-year-old patients undergoing femoral rotational osteotomy with intramedullary nailing over 15 years.
• Analysis of patient demographics, surgical details (concomitant procedures, nail material, screw construct), and radiographic measurements (osteotomy location, canal fit).
• Comparison of patients with nonunion versus those with successful healing.

Main Results:

• Nonunion occurred in 4.9% (10/203) of procedures; overall complication rate was 6.9%.
• Higher age, weight, and BMI were associated with increased nonunion risk.
• Static interlocking screws and lower canal fit ratio significantly correlated with nonunion.

Conclusions:

• Nonunion risk is elevated in older, heavier adolescents with higher BMI.
• Static interlocking screws and inadequate canal fit are significant risk factors.
• Optimizing canal fit and considering dynamic interlocking screws may mitigate nonunion risk.