Medial augmentation plating of aseptic distal femoral nonunions

• Published in: BMC musculoskeletal disorders 2023-07, Vol.24 (1), p.554-554, Article 554
• Main Authors: Lotzien, Sebastian, Baron, Darius, Rosteius, Thomas, Cibura, Charlotte, Ull, Christopher, Schildhauer, Thomas Armin, Geßmann, Jan
• Format: Article
• Language: English
• Subjects: Augmentation plating; Bone grafts; Bone Plates - adverse effects; Bone surgery; Care and treatment; Debridement; Distal femur; Erythema; Femoral Fractures - diagnostic imaging; Femoral Fractures - etiology; Femoral Fractures - surgery; Femoral nonunion; Femur; Femur - surgery; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fracture Healing; Fractures; Fractures, Ununited; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Hospitals; Humans; Implant failure; Infections; Injuries; Internal fixation in fractures; Knee; Medial plate; Musculoskeletal diseases; Nonunion; Patient outcomes; Patients; Pseudarthrosis; Retrospective Studies; Skin & tissue grafts; Surgery; Titanium; Transplants & implants; Trauma; Treatment Outcome
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-023-06675-5

Distal femur nonunions are well-recognized contributors to persistent functional disability, with limited data regarding their treatment options. In the current study, we asked whether additional medial augmentation plating is a feasible treatment option for patients with aseptic distal femoral nonunion and intact lateral implants. We conducted a single-center, retrospective study including 20 patients treated for aseptic distal femoral nonunion between 2002 and 2017. The treatment procedure included a medial approach to the distal femur, debridement of the nonunion site, bone grafting and medial augmentation plating utilizing a large-fragment titanium plate. Outcome measures were bone-related and functional results, measured by the Hospital for Special Surgery Knee Rating Scale (HSS) and the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D). Eighteen of 20 nonunions showed osseous healing at 8.16 ± 5.23 (range: 3-21) months after augmentation plating. Regarding functional results, the mean HSS score was 74.17 ± 11.12 (range: 57-87). The mean SMFA-D functional index was 47.38 ± 16.78 (range 25.74-71.32) at the last follow-up. Index procedure-associated complications included two cases of persistent nonunion and one case of infection. According to the assessed outcome measures, augmentation plating is a feasible treatment option, with a high proportion of patients achieving bony union and good functional outcomes and a few patients experiencing complications.