The management of femoral diaphyseal nonunions

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, followup 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.