Internal fixation with locking plates and bone grafting for femoral nonunion and/or bone defects

Abstract

Objective To evaluate the clinical effects of internal fixation with locking plates and bone grafting for femoral nonunion and /or bone defects.MethodsFrom June 2005 to June 2010, 80 cases of nonunion of femoral fractures and/or bone defects were treated with internal locking plating and bone grafting. There were 60 males and 20 females, with a mean age of 38.2 years (range, 8 to 68 years) and a mean nonunion history of 16.5 months (range, 6 to 150 months) . The causes for nonunion were failure of internal fixation in 60 cases, failure of external fixation in 5 cases and infection in 15 cases. There were 15 hypertrophic, 10 malnourished, 40 atrophic (including 20 bone defects) and 15 infective nonunions.Fifty-eight cases were treated with less invasive stabilization system and 22 cases with locking compression plate. Bone grafting was performed for all cases, including 35 cases of autologous iliac bone grafting, 10 cases of local sliding plus bony callus grafting, 8 cases of autologous iliac bone plus allograft bone grafting, 7 cases of allograft bone plus Wright DBM artificial bone grafting and 20 cases of free vascularized fibular grafting.ResultsAll cases were followed up for a mean period of 13.8 months (range, 6 to 36 months). All cases healed after a mean duration of 5.3 months (range, 4 to 8 months) without wound infection or fixator failure.By the Sanders scale, of the 16 cases of proximal femoral nonunion, the hip functions were rated as excellent in 10, good in 5 and fair in one, with an excellent to good rate of 93.8％. By the American Knee Society Score (KSS), of the 40 cases of distal femoral nonunion, the knee function was rated as excellent in 25, good in 12 and fair in 3, with an excellent to good rate of 92. 5％. By the Sanders and KSS systems, of the 24 cases of femoral shaft nonunion, the hip and knee functions were rated as excellent in 21, good in 2 and fair in one,with an excellent to good rate of 95. 8％.ConclusionAs internal fixation with locking plates and bone grafting can significantly promote fracture union, it is an effective treatment for nonunion of femoral fractures. Key words: Femoral fracutres; Fracture, ununited; Bone plates; Fracture fixation, internal