Femoral diaphysis malunion: An overview

Area of Science:

• Orthopaedic Surgery
• Traumatology
• Biomechanical Engineering

Background:

• Femoral diaphyseal fractures are common, with malunion a significant complication, especially in delayed or resource-limited settings.
• Malunion can lead to angular, rotational, or multiplanar deformities, causing gait disturbance, limb-length discrepancy, and chronic pain.
• Corrective osteotomy is often necessary to restore function and alleviate symptoms.

Purpose of the Study:

• To present a structured approach for assessing and managing femoral diaphyseal malunion.
• To review contemporary operative strategies for deformity correction.
• To highlight the role of modern techniques in improving surgical outcomes.

Main Methods:

• Narrative review of literature on femoral diaphyseal malunion assessment and management.
• Analysis of clinical and radiological evaluation methods.
• Discussion of operative strategies including intramedullary nailing, plate fixation, external fixation, and fixator-assisted techniques.
• Focus on Computer Hexapod-Assisted Orthopaedic Surgery (CHAOS) and adjuncts like 3D planning and patient-specific guides.

Main Results:

• A systematic, patient-specific approach is crucial for successful malunion correction.
• Modern techniques, including CHAOS, enable precise multiplanar correction and immediate definitive fixation.
• Adjuncts like poller screws and patient-specific guides enhance accuracy and stability.
• Fixator-assisted correction offers improved intraoperative control, avoiding prolonged external fixation.

Conclusions:

• Femoral diaphyseal malunion presents complex challenges requiring meticulous planning and execution.
• Modern fixator-assisted and computer-guided techniques facilitate reliable restoration of alignment and rotation.
• Systematic management improves patient function and quality of life.