DISTAL FEMORAL NONUNION - TREATMENT WITH A RETROGRADE INSERTED LOCKEDINTRAMEDULLARY NAIL

Between March 1989 and August 1993, 16 distal femoral nonunions (16 pa tients) were treated using the supracondylar intramedullary nail. The time between the initial event and retrograde nailing averaged 33 mont hs. The nonunion level was infraisthmal in four patients and supracond ylar in 12. Operative technique involved retrograde insertion of a rea med supracondylar intramedullary nail through the intercondylar notch. Follow-up was available on all patients and averaged 20 months (range 9-46). Four nonunions (25%) united with a single surgery at an averag e of 17 months. A fifth nonunion united at 21 months after nail dynami zation and subsequent nail breakage. The nonunions of two additional p atients united after exchange of a broken retrograde nail. Additional surgical procedures were performed in six of the remaining nine patien ts in an attempt to gain union. At an average follow-up of 16 months ( range 9-23), none of the nine had united. Nine nails fractured at an a verage of 11 months, all through a screw hole near the nonunion. Based on these results, we cannot recommend use of the supracondylar intram edullary nail in its present form for the treatment of distal femoral nonunions.