title: One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.
abstract: OBJECTIVE
  To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening.
  
  
  METHODS
  Retrospective.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by <or=4 cm aided by a laminar spreader, insertion of a static locked nail, and grafting of corticocancellous bone. Mize's classification for clinical function was used for final patient evaluation.
  
  
  RESULTS
  A total of 32 nonunions were followed-up for at least 1 year (median 3.8 years; range 1.2-6.9 years), and 29 fractures healed. The median union period was 4.5 months (range 3-6 months). Three fractures persistently failed to heal. One was treated successfully with exchange nailing, and the remaining two patients were followed annually and had no symptoms. At the latest follow-up, all 32 patients had achieved a satisfactory outcome. The average lengthening was 2.5 cm (range 1.5-3.5 cm).
  
  
  CONCLUSIONS
  One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.
authors.affiliation: Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung Institute of Technology, Taoyuan, Taiwan.ccwu@mail.cgu.edu.tw
authors.forename: Chi-Chuan
authors.initials: CC
authors.lastname: Wu
authors.forename: Zhon-Liau
authors.initials: ZL
authors.lastname: Lee
mesh_terms: D000328:Adult; D001852:Bone Lengthening / Q000379:methods*; D001863:Bone Screws; D003646:Debridement; D004434:Early Ambulation; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005599:Fractures, Ununited / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies