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The management of femoral diaphyseal nonunions
J A Cove1, D W Lhowe, J B Jupiter
1Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
Objective:
To assess the efficacy of treatment and develop an algorithm for management of nonunions of the femoral diaphysis.
Study Design:
Retrospective.
Setting:
University hospital.
Methods:
Forty-four patients treated at one institution for nonunion of the femoral diaphysis were studied. Thirteen of these patients had a history of infection. After debridement (where appropriate) and repair of the femoral nonunion, follow-up averaged twenty-eight months (range, 24 to 108 months). All patients were examined at final follow-up.
Results:
Thirty-three patients achieved union after one procedure, and eight patients achieved union after additional procedures. One patient underwent above-knee amputation, and two patients remained ununited at the time of their final follow-up. Time to union averaged 11.8 months. Seventeen patients healed with more than two centimeters of shortening, and ten patients lost more than 30 degrees of knee flexion.
Conclusion:
Established femoral diaphyseal nonunions can be treated effectively, even in the presence of chronic sepsis. Selective use of a vascularized fibula transfer has proven beneficial in addressing intercalary defects. Plate fixation, with or without a vascularized fibula transfer, has been the predominant mode of skeletal stabilization in more complex reconstructions.