title: Complex nonunion of fractures of the femoral shaft treated by wave-plate osteosynthesis.
abstract: We have treated 42 consecutive complex ununited fractures of the femoral shaft by wave-plate osteosynthesis at five different medical centres. There were 13 with previous infection, 12 with segmental cortical defects, and 3 were pathological fractures. In 39 cases there had been previous internal fixation and 21 patients had had more than one earlier operation. Union was achieved in 41 patients at an average of six months, although three had required a second bone graft. Two patients had recurrence of infection and in one this resulted in the persistence of nonunion. There were no failures of the implant. All 41 patients with union are now fully weight-bearing, but four have a leg-length discrepancy, one has axial malalignment, and nine have residual stiffness of the knee. These results are surprisingly good, despite the complexity of the initial problem, and appear to confirm the biological and mechanical advantages of the wave plate over the conventional plate for such cases.
authors.affiliation: Department of Orthopaedics, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: D
authors.initials: D
authors.lastname: Ring
authors.forename: J B
authors.initials: JB
authors.lastname: Jupiter
authors.forename: R A
authors.initials: RA
authors.lastname: Sanders
authors.forename: J
authors.initials: J
authors.lastname: Quintero
authors.forename: V M
authors.initials: VM
authors.lastname: Santoro
authors.forename: R
authors.initials: R
authors.lastname: Ganz
authors.forename: R K
authors.initials: RK
authors.lastname: Marti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D001863:Bone Screws; D016025:Bone Transplantation; D002908:Chronic Disease; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods*; D005597:Fractures, Open / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies