title: Three-stage treatment protocol for recalcitrant distal femoral nonunion.
abstract: BACKGROUND
  In this study, we proposed a three-stage treatment protocol for recalcitrant distal femoral nonunion and aimed to analyze the clinical results.
  
  
  METHODS
  We retrospective reviewed 12 consecutive patients with recalcitrant distal femoral nonunion undergoing our three-stage treatment protocol from January 2010 to December 2014 in our institute. The three-stage treatment protocol comprised debridement of the nonunion site, lengthening to eliminate leg length discrepancy, deformity correction, stabilization with a locked plate, filling of the defect with cement spacer for inducing membrane formation, and bone reconstruction using a cancellous bone autograft (Masquelet technique) or free vascularized fibular bone graft. The bone union time, wound complication, lower limbs alignment, amount of lengthening, knee range of motion, and functional outcomes were evaluated.
  
  
  RESULTS
  Osseous union with angular deformity <5° and leg length discrepancy <1 cm were achieved in all the patients. The average amount of lengthening was 5.88 cm (range 3.5-12 cm). Excellent or good outcomes were obtained in 9 patients.
  
  
  CONCLUSIONS
  Although the current study involved only a small number of patients and the intervention comprised three stages, we believe that such a protocol may be a valuable alternative for the treatment of recalcitrant distal femoral nonunion.
authors.affiliation: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, ROC.
authors.forename: Ching-Hou
authors.initials: CH
authors.lastname: Ma
authors.affiliation: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, ROC.
authors.forename: Yen-Chun
authors.initials: YC
authors.lastname: Chiu
authors.affiliation: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, ROC.
authors.forename: Yuan-Kun
authors.initials: YK
authors.lastname: Tu
authors.affiliation: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, ROC.
authors.forename: Cheng-Yo
authors.initials: CY
authors.lastname: Yen
authors.affiliation: Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung City, Taiwan, ROC. edaortho@edah.org.tw.
authors.forename: Chin-Hsien
authors.initials: CH
authors.lastname: Wu
mesh_terms: D000328:Adult; D001860:Bone Plates; D016025:Bone Transplantation / Q000379:methods*; D060826:Cementoplasty / Q000379:methods*; D002985:Clinical Protocols; D003646:Debridement / Q000379:methods*; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000601:surgery; D005360:Fibula / Q000637:transplantation; D005599:Fractures, Ununited / Q000150:complications / Q000601:surgery*; D006801:Humans; D018889:Ilizarov Technique; D007870:Leg Length Inequality / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone defect; Bone reconstruction; Distal femoral nonunion; Soft-tissue lengthening