Treatment of supracondylar nonunions of the femur with plate fixation and bone graft

Background: The purpose of this study was to review the results of single and double-plate fixation combined with grafting with bone from the iliac crest performed by one surgeon as treatment for supracondylar nonunion of the femur. Methods: We performed a retrospective study of eighteen adult patients in whom a nonunion of the supracondylar region of the femur had been treated with single or double-plate fixation and autologous bone graft. The average time from the initial treatment of the fracture or the osteotomy to the index repair of the nonunion was fifteen months (range, five to thirty-six months), and nine patients had had a total of fifteen operations between the initial treatment and the repair of the nonunion. Two of these patients had had at least three procedures. Thirteen double plates, four single plates, and one interfragmentary screw,were used for fixation of the nonunions, with onlay autologous bone graft used in all patients. The average time from the repair of the nonunion to the latest follow-up examination was twenty-six months (range, six to 120 months). Results: By the time of the latest follow-up examination, all eighteen nonunions had healed. One patient had needed repeat double-plate fixation and autologous bone-grafting to obtain union. Two patients had had the hardware removed because of pain or infection, one patient had had an implanted electrical bone stimulator removed, and one patient had had a quadriceps-plasty to treat restricted motion of the knee. There were only three complications. These included one infection, which resolved with irrigation and debridement and the use of antibiotics; Loss of motion of one knee; and one malunion. The average range of motion of the knee at the latest follow-up examination was 101 degrees (range, 10 to 135 degrees). Conclusions: Rigid plate fixation and autologous bone-grafting is an effective technique for the treatment of nonunions of the supracondylar region of the femur.