Retrograde dynamic locked nailing for femoral supracondylar nonunions after plating.
BACKGROUND
No surgical procedure has clearly proven superior in treating femoral supracondylar nonunions after plating. All traditional devices have limitations. A technique for improving the approach of retrograde locked nailing to increase a success rate was developed.


METHODS
Twenty-one consecutive adult patients with 21 femoral supracondylar nonunions after plating were treated by lateral approach. Soft-tissue detachment was minimized as much as possible. Retrograde dynamic locked nailing and cancellous bone grafting were consequently performed. Postoperatively, protected weight bearing with exercise of knee range of motion was encouraged as early as possible.


RESULTS
Eighteen patients were followed up for an average of 3.3 years (range, 1.2-6.5 years). Sixteen nonunions healed with a union rate of 88.9% and an average union period of 4.2 months (range, 3.5-5.0 months). Although two nonunions persisted without further treatment because of patient hesitation, all patients achieved satisfactory functional outcome.


CONCLUSIONS
Although neither surgical technique is clearly superior for treating femoral supracondylar nonunions after plating, the lateral approach with retrograde dynamic locked nailing and cancellous bone grafting may prove to be the optimal treatment alternatives. Minimizing soft-tissue destruction during surgery in addition to protected weight bearing through the treatment course may effectively raise the success rate.
Wu
Chi-Chuan
CC
Department of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan. ccwu@mail.cgu.edu.tw
D000328:Adult; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular; D017211:Treatment Failure; D016896:Treatment Outcome; D016474:Weight-Bearing