Outcomes of Nonunion Repair for Distal Femur Fracture

Area of Science:

• Orthopedic surgery
• Trauma surgery
• Bone healing research

Background:

• Distal femur nonunions present a significant challenge in orthopedic trauma.
• Identifying factors predicting treatment success is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the outcomes of aseptic distal femur nonunion repair.
• To identify factors associated with persistent (recalcitrant) nonunion after surgical intervention.

Main Methods:

• Retrospective cohort study including 102 skeletally mature patients with distal femur nonunions (AO/OTA 33A or 33C).
• Analysis of patient, injury, and treatment variables to identify predictors of recalcitrant nonunion.
• Comparison of fixation methods including plate alone, nail alone, graft alone, and dual-column constructs.

Main Results:

• The overall rate of recalcitrant nonunion was 23%.
• Fracture-related infection (FRI) after repair significantly increased the risk of recalcitrant nonunion (47% vs. 18%).
• Dual-column fixation (e.g., nail-plate combination) demonstrated a significantly lower rate of recalcitrant nonunion (3%) compared to other methods (0-40%).

Conclusions:

• Aseptic distal femur nonunion repair has a substantial risk of recalcitrant nonunion, occurring in nearly one in four patients.
• Dual-column fixation constructs are associated with a decreased risk of recalcitrant nonunion, suggesting improved stability and healing potential.