USE OF ENDOSTEAL SUBSTITUTION IN THE TREATMENT OF RECALCITRANT NONUNIONS OF THE FEMUR - REPORT OF 7 CASES

Seven patients, with an average age of 53 years, were treated for bone loss or recalcitrant nonunions of the femur. The average duration fro m initial injury to presentation was 37 months (range 4-92 months). Th e patients had undergone one to eight (mean, 3.9) previous surgical at tempts at achieving union. The nonunion involved the diaphysis in thre e patients, the diaphyseal-supracondylar junction in three patients, a nd the pertrochanteric region in one patient. All patients were treate d using a standard lateral plate in combination with an endosteal plat e and primary iliac crest bone grafting. The mean surgical time was 6. 3 h, and the average blood loss was 1.7 L. There were three complicati ons, including one superficial wound infection, one nonfatal pulmonary embolism, and one wound hematoma. At a mean follow-up of 12.6 months (range 4-24 months), all fractures had healed with an average time to union of 19.2 weeks (range 15-36 weeks). Knee flexion averaged 118 deg rees (range 100-135 degrees), and all patients were satisfied with the operative procedure. Endosteal plating, in combination with a standar d lateral plate and iliac crest bone-grafting, can successfully treat difficult nonunions of the femur.