Functional and radiological outcome following operative skeletal stabilisation with bone grafting in distal femur non-unions: a study of 21 patients

Navin Balasubramanian; Sindhuja P.

doi:10.18203/issn.2455-4510.IntJResOrthop20170435

Authors

Navin Balasubramanian Department of Orthopaedics, Saveetha Medical College, Chennai
Sindhuja P. Department of Pathology, Saveetha Medical College, Chennai

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20170435

Keywords:

Distal femur non-unions, Native bone setter, Knee society score

Abstract

Background: The study was done to assess the functional and radiological outcome after operative skeletal stabilisation with bone grafting in 21 patients who presented to us with distal femur non-unions.

Methods: Between August 2008 and October 2015, 21 patients (M:F- 14:7) with established non-unions of the distal femur were included. All patients presented to us with established non-union following treatment with a native bone setter using splints. There were 16 patients with AO Type A, 4 with AO Type B and one patient with Type C. All patients underwent open reduction, internal fixation with plate and screws and bone grafting. Serial follow-ups were done at 4, 8, 12, 16, 20, 24 weeks and 6 monthly thereafter.

Results: All 21 patients had complete fracture healing at average of 19 weeks (Range 16-24). Knee flexion (ROM) improved from an average 16® pre-op to 66® post-operatively. There were no implant failure, infection or non-unions in our study. The Knee Society score improved from 54 pre-operatively to 74 post-operatively at last follow-up.

Conclusions: Even in established non-unions, good results can be expected if good surgical technique is followed and with bone grafting satisfactory union rated can be achieved. Knee ROM also improves with dedicated postoperative rehabilitation.

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Author Biographies

Navin Balasubramanian, Department of Orthopaedics, Saveetha Medical College, Chennai

Associate Professor in Orthopaedics

Sindhuja P., Department of Pathology, Saveetha Medical College, Chennai

Junior Resident

Dept of Pathology

References

Westgeest J, Weber D, Dulai SK, Bergman JW, Buckley R, Beaupre LA. Factors Associated With Development of Nonunion or Delayed Healing After an Open Long Bone Fracture: A Prospective Cohort Study of 736 Subjects. J Orthop Trauma. 2016;30(3):149-55.

Yue B, Ng A, Tang H, Joseph S, Richardson M Delayed healing of lower limb fractures with bisphosphonate therapy. Ann R Coll Surg Engl. 2015;97(5):333-8.

Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral fractures: a systematic review. Orthop Surg. 2013;5(1):46-50.

Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury. 2014;45(3):554-9.

Hoffmann MF, Jones CB, Sietsema DL, Tornetta III P, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res. 2013;8:43.

Maheswari P, Maheswari P. Non Union Distal Femur Fracture: Causes and Management Options. Trauma Int. 2016;1(2):28-33.

Wang JW, Weng LH. Treatment of Distal Femoral Nonunion with Internal Fixation, Cortical Allograft Struts, and Autogenous Bone-Grafting. J Bone Joint Surg Am. 2003;85(3):436-40.

Vaishya R, Singh AP, Hasija R, Singh AP. Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis. Knee Surg Sports Traumatol Arthrosc. 2011;19:1137.

Waseem Z, Ford M, Syed K, Flannery J. Chronic nonunion in a patient with bilateral supracondylar distal femur fractures treated successfully with twice daily low-intensity pulsed ultrasound. PMR. 2010;2(2):159-6.