THE MANAGEMENT OF FEMORAL DIAPHYSEAL NONUNIONS

Objective: To assess the efficacy of treatment and develop an algorith m for management of nonunions of the femoral diaphysis. Study Design: Retrospective. Setting: University hospital. Methods: Forty-four patie nts treated at one institution for nonunion of the femoral diaphysis w ere studied. Thirteen of these patients had a history of infection. Af ter debridement (where appropriate) and repair of the femoral: nonunio n, followup averaged twenty-eight months (range, 24 to 108 months). Al l patients were examined at final follow-up. Results: Thirty-three pat ients achieved union after one procedure, and eight patients achieved union after additional procedures. One patient underwent above-knee am putation, and two patients remained ununited at the time of their fina l follow-up. Time to union averaged 11.8 months. Seventeen patients he aled with more than two centimeters of shortening, and ten patients lo st more than 30 degrees of knee flexion. Conclusion: Established femor al diaphyseal nonunions can be treated effectively, even in the presen ce of chronic sepsis: Selective use of a vascularized fibula transfer has proven beneficial in addressing intercalary defects. Plate fixatio n, with or without a vascularized fibula transfer, has been the predom inant mode of skeletal stabilization in more complex reconstructions.