Distal Femur Nonunion Patients Can Expect Good Outcomes

 

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Abstract

The purpose of this study is to describe our experience with distal femur nonunions and to report on the functional recovery of patients treated for these injuries. Twenty-two patients with an established distal femur nonunion were identified and followed prospectively. Results were compared with a control group consisting of 18 similar patients who had sustained an acute distal femur fracture. Compared with acute fracture patients, patients with a nonunion were more likely to have had an open fracture at initial injury (p = 0.02) and required a longer time to heal after final surgery (p = 0.054). No demographic variables were found to be predictive of complications, Short Musculoskeletal Functional Assessment scores, or time to union. These results show that patients with a distal femoral nonunion can expect to attain similar ultimate outcomes to patients receiving treatment for an acute distal femur fracture. Unlike the development of nonunions following other types of fracture, such as the hip, distal femur nonunions do not portend poor functional outcomes as long as bone union is achieved.

• References

• 1 Schütz M, Müller M, Krettek C , et al. Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury 2001; 32 (Suppl. 03) SC48-SC54
  CrossrefPubMedGoogle Scholar
• 2 Syed AA, Agarwal M, Giannoudis PV, Matthews SJ, Smith RM. Distal femoral fractures: long-term outcome following stabilisation with the LISS. Injury 2004; 35 (6) 599-607
  CrossrefPubMedGoogle Scholar
• 3 Markmiller M, Konrad G, Südkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications?. Clin Orthop Relat Res 2004; 426 (426) 252-257
  CrossrefPubMedGoogle Scholar
• 4 Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma 2006; 20 (5) 366-371
  CrossrefPubMedGoogle Scholar
• 5 Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results. Injury 2001; 32 (Suppl. 03) SC32-SC47
  CrossrefPubMedGoogle Scholar
• 6 Hakeos WM, Richards JE, Obremskey WT. Plate fixation of femoral nonunions over an intramedullary nail with autogenous bone grafting. J Orthop Trauma 2011; 25 (2) 84-89
  CrossrefPubMedGoogle Scholar
• 7 Bellabarba C, Ricci WM, Bolhofner BR. Indirect reduction and plating of distal femoral nonunions. J Orthop Trauma 2002; 16 (5) 287-296
  CrossrefPubMedGoogle Scholar
• 8 Gardner MJ, Toro-Arbelaez JB, Harrison M, Hierholzer C, Lorich DG, Helfet DL. Open reduction and internal fixation of distal femoral nonunions: long-term functional outcomes following a treatment protocol. J Trauma 2008; 64 (2) 434-438
  Google Scholar
• 9 Thomson AB, Driver R, Kregor PJ, Obremskey WT. Long-term functional outcomes after intra-articular distal femur fractures: ORIF versus retrograde intramedullary nailing. Orthopedics 2008; 31 (8) 748-750
  CrossrefPubMedGoogle Scholar
• 10 Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. 2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res 2011; 469 (6) 1757-1765
  CrossrefPubMedGoogle Scholar
• 11 Winquist RA, Hansen Jr ST, Clawson DK. Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66 (4) 529-539
  PubMedGoogle Scholar
• 12 Fankhauser F, Gruber G, Schippinger G , et al. Minimal-invasive treatment of distal femoral fractures with the LISS (Less Invasive Stabilization System): a prospective study of 30 fractures with a follow up of 20 months. Acta Orthop Scand 2004; 75 (1) 56-60
  CrossrefPubMedGoogle Scholar
• 13 Kayali C, Agus H, Turgut A. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. J Orthop Sci 2007; 12 (5) 458-465
  CrossrefPubMedGoogle Scholar
• 14 Zlowodzki M, Obremskey WT, Thomison JB, Kregor PJ. Functional outcome after treatment of lower-extremity nonunions. J Trauma 2005; 58 (2) 312-317
  CrossrefPubMedGoogle Scholar
• 15 Bowen CV, Botsford DJ, Hudak PL, Evans PJ. Microsurgical treatment of septic nonunion of the tibia. Quality of life results. Clin Orthop Relat Res 1996; 332 (332) 52-61
  CrossrefPubMedGoogle Scholar
• 16 Blomfeldt R, Törnkvist H, Ponzer S, Söderqvist A, Tidermark J. Displaced femoral neck fracture: comparison of primary total hip replacement with secondary replacement after failed internal fixation: a 2-year follow-up of 84 patients. Acta Orthop 2006; 77 (4) 638-643
  CrossrefPubMedGoogle Scholar
• 17 Gustilo RB, Gruninger RP, Davis T. Classification of type III (severe) open fractures relative to treatment and results. Orthopedics 1987; 10 (12) 1781-1788
  PubMedGoogle Scholar
• 18 Moore TJ, Watson T, Green SA, Garland DE, Chandler RW. Complications of surgically treated supracondylar fractures of the femur. J Trauma 1987; 27 (4) 402-406
  CrossrefPubMedGoogle Scholar
• 19 Chapman MW, Finkemeier CG. Treatment of supracondylar nonunions of the femur with plate fixation and bone graft. J Bone Joint Surg Am 1999; 81 (9) 1217-1228
  PubMedGoogle Scholar
• 20 Karladani AH, Granhed H, Kärrholm J, Styf J. The influence of fracture etiology and type on fracture healing: a review of 104 consecutive tibial shaft fractures. Arch Orthop Trauma Surg 2001; 121 (6) 325-328
  CrossrefPubMedGoogle Scholar
• 21 Koval KJ, Seligson D, Rosen H, Fee K. Distal femoral nonunion: treatment with a retrograde inserted locked intramedullary nail. J Orthop Trauma 1995; 9 (4) 285-291
  CrossrefPubMedGoogle Scholar
• 22 Claes LE, Heigele CA, Neidlinger-Wilke C , et al. Effects of mechanical factors on the fracture healing process. Clin Orthop Relat Res 1998; 355 (355, Suppl): S132-S147
  PubMedGoogle Scholar