title: The management of femoral diaphyseal nonunions.
abstract: OBJECTIVE
  To assess the efficacy of treatment and develop an algorithm for management of nonunions of the femoral diaphysis.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  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, follow-up 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Cove
authors.forename: D W
authors.initials: DW
authors.lastname: Lhowe
authors.forename: J B
authors.initials: JB
authors.lastname: Jupiter
authors.forename: J M
authors.initials: JM
authors.lastname: Siliski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology; D001860:Bone Plates; D016025:Bone Transplantation; D002648:Child; D003646:Debridement; D018483:Diaphyses / Q000293:injuries / Q000382:microbiology; D016267:External Fixators; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005592:Fracture Fixation / Q000295:instrumentation / Q000379:methods*; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009989:Orthotic Devices; D011379:Prognosis; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents