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The Journal of Bone and Joint Surgery (American) 85:436-440 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Treatment of Distal Femoral Nonunion with Internal Fixation, Cortical Allograft Struts, and Autogenous Bone-Grafting

Jun-Wen Wang, MD and Lin-Hsiu Weng, MD

Investigation performed at Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan

Jun-Wen Wang, MD
Lin-Hsiu Weng, MD
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung,123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung, Taiwan. E-mail address for J.-W. Wang: lee415{at}adm.cgmh.org.tw

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The purpose of this retrospective study was to analyze the results of treatment of nonunions of the distal part of the femur with internal fixation combined with cortical allograft struts and autogenous bone-grafting.

Methods: Thirteen patients with a distal femoral nonunion were treated with open reduction and internal fixation combined with deep-frozen cortical allograft struts and autogenous iliac bone grafts. The level of nonunion was infra-isthmal in three patients and supracondylar in ten. Ten nonunions were fixed with a blade-plate or condylar buttress plate; two, with an antegrade locked nail; and one, with an antegrade locked nail and a compression plate. Seven unicortical, five bicortical, and one tricortical allograft struts, with an average length of 10 cm, were used. Autogenous iliac bone grafts were inserted into the nonunion site and between the allograft and host femur. The average time from the surgery to the latest follow-up examination was thirty-four months (range, twelve to seventy months).

Results: All nonunions united, at an average of five months. The average arc of knee motion improved from 45° preoperatively to 73° postoperatively. According to The Hospital for Special Surgery knee rating system, the average knee score improved from 20 points preoperatively to 71 points at the latest follow-up examination. Three patients had hardware removed after healing of the nonunion, and one patient underwent quadricepsplasty for knee contracture. There were no postoperative infections. Two patients had shortening of the limb of >2 cm.

Conclusion: Open reduction and internal fixation supplemented with allograft struts and autogenous bone graft is an effective treatment for nonunion of the distal part of the femur.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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