Indirect reduction and plating of distal femoral nonunions.

OBJECTIVE

To observe and report the clinical results of indirect reduction and plating in the treatment of distal femoral nonunions.

DESIGN

Prospective consecutive study.

SETTING

Regional trauma center.

PATIENTS

A consecutive series of twenty patients with nonunion of the distal femur, nineteen of whom had undergone operative initial fracture care.

INTERVENTION

Surgical treatment with indirect reduction techniques using the 95-degree condylar blade-plate, condylar buttress plate, or locking condylar plate with autologous cancellous bone grafting in 45 percent of patients. Emphasis was placed on preoperative planning, intraoperative attention to soft tissue sparing, and selection of the appropriately applied implant to correct deformity, when present, and obtain union.

MAIN OUTCOME MEASUREMENTS

Healing rate and time, operative blood loss and time, incidence of complications including instrumentation failure, loss of fixation, infection, and postoperative malalignment. Both the Böstman and Hospital for Special Surgery knee scores were used to quantify postoperative clinical results at an average follow-up of twenty-three months (range 12 to 60 months).

RESULTS

All twenty nonunions healed without further intervention at an average of fourteen weeks (range 12 to 20 weeks) postoperatively. There were no intraoperative complications. Average operative time was 154 minutes (range 90 to 240 minutes), and blood loss was 245 milliliter (range 100 to 400 milliliters). Average Böstman knee score improved from eighteen to twenty-five points, and average Hospital for Special Surgery score improved from fifty-eight to eighty points. Average arc of knee motion improved from 92 to 110 degrees. There was no patient with significant postoperative axial or rotational malalignment (>5 degrees) or limb length discrepancy (more than one centimeter). One patient with a history of osteomyelitis became infected postoperatively and healed without consequence after a debridement procedure.

CONCLUSIONS

Contemporary plating techniques are effective in the treatment of distal femoral nonunions. Union occurred reliably with few complications, resulting in a majority of good or excellent clinical results.