title: Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting.
abstract: BACKGROUND
  The purpose of this retrospective study was to analyze the results of treatment of nonunions of the distal part of the femur with internal fixation combined with cortical allograft struts and autogenous bone-grafting.
  
  
  METHODS
  Thirteen patients with a distal femoral nonunion were treated with open reduction and internal fixation combined with deep-frozen cortical allograft struts and autogenous iliac bone grafts. The level of nonunion was infra-isthmal in three patients and supracondylar in ten. Ten nonunions were fixed with a blade-plate or condylar buttress plate; two, with an antegrade locked nail; and one, with an antegrade locked nail and a compression plate. Seven unicortical, five bicortical, and one tricortical allograft struts, with an average length of 10 cm, were used. Autogenous iliac bone grafts were inserted into the nonunion site and between the allograft and host femur. The average time from the surgery to the latest follow-up examination was thirty-four months (range, twelve to seventy months).
  
  
  RESULTS
  All nonunions united, at an average of five months. The average arc of knee motion improved from 45 degrees preoperatively to 73 degrees postoperatively. According to The Hospital for Special Surgery knee rating system, the average knee score improved from 20 points preoperatively to 71 points at the latest follow-up examination. Three patients had hardware removed after healing of the nonunion, and one patient underwent quadricepsplasty for knee contracture. There were no postoperative infections. Two patients had shortening of the limb of >2 cm.
  
  
  CONCLUSIONS
  Open reduction and internal fixation supplemented with allograft struts and autogenous bone graft is an effective treatment for nonunion of the distal part of the femur.
  
  
  METHODS
  Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, Nia Sung Hsiang, Taiwan. lee415@adm.cgmh.org.tw
authors.forename: Jun-Wen
authors.initials: JW
authors.lastname: Wang
authors.forename: Lin-Hsiu
authors.initials: LH
authors.lastname: Weng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005593:Fracture Fixation, Internal; D017102:Fracture Healing; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007719:Knee Joint / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous