Outcomes of Distal Femur Nonunions Treated with a Combined Nail/Plate Construct and Autogenous Bone Grafting

Abstract

SummaryIn this study, we sought to retrospectively evaluate union and infection rates after treatment of distal femur nonunions using a combined nail/plate construct with autogenous bone grafting. 10 patients treated at a Level I Trauma Center for nonunion of a femoral fracture using a combined nail/plate construct from 2004 to 2014 were included in the study. Union rate and postoperative infection rate were recorded.10 patients underwent treatment for nonunion of the distal femur. Mean interval from index surgery to nonunion repair was 12 months (range 4-36 months). All 10 patients achieved union at an average of 3.9 months (range 2.3-8 months) after initial nonunion repair. Treatment of distal femur nonunions with a combined nail/plate construct and autogenous bone grafting results in a high rate of union with a low complication rate. This technique combines two straightforward procedures familiar to orthopaedic trauma surgeons and offers distinct advantages including: availability of adequate bone graft volume, absence of donor site morbidity, and increased construct stability that may permit earlier weight-bearing.

Intramedullary Nail and Plate Combination Technique for Peri-Implant Both-Bone Forearm Fractures

“…Variations of the above technique have been used successfully in the femur and tibia [ 14 , 15 ]; however, we are unaware of previously published reports of its use in the forearm. We are hopeful that this technique can be used by others in the future when select circumstances are present.…”

Augmented Fixation for Fractures of the Appendicular Skeleton

“…The combination of a nail and plate can also be used for distal femoral nonunion. Attum et al 21 published a series of 10 patients with distal femoral nonunions treated with autologous bone grafting, intramedullary nail placement, and subsequent plate fixation. All fractures healed at a mean of 4 months.…”

Hematopoietic Wnts Modulate Endochondral Ossification During Fracture Healing

“…This includes a multitude of causes that have a cumulative or additive effects, including local bone marrow suppression, poor vascularity, immunosuppression, and aberrant cellular signaling ( 24 – 27 ). Introducing autologous bone graft and bone marrow aspirate concentrate to the fracture site to promote healing in fracture non-unions has proven to be clinically efficacious ( 28 – 31 ). These therapeutic interventions introduce several cell types, including cells of hematopoietic origin that are important for fracture healing ( 19 ).…”