Modified Retrograde-Locked Nailing for Aseptic Femoral Supracondylar Nonunion With Severe Osteoporosis in Elderly Patients

Abstract

Femoral supracondylar nonunions in elderly patients are uncommon. To date, there is no convincing technique for managing this condition. When the nonunion is associated with severe osteoporosis, treatment becomes even more complicated. We developed a modified retrograde-locked nailing technique to treat this complex lesion. Twenty-four aseptic femoral supracondylar nonunions with severe osteopenia in 24 elderly patients (aged ≥65 years) were treated. A retrograde femoral-locked nail was inserted in the dynamic mode. Next, the medial ½ to 2/3 marrow cavity in the nonunion site was filled with bone cement, and the lateral 1/3 to ½ marrow cavity received a cancellous bone graft with or without a bone graft substitute. A cylindrical brace was applied for 3 weeks postoperation. Early ambulation with a walker or wheelchair was encouraged. Twenty patients were followed up for an average period of 2.5 years (range, 1.1-4.5 years), and 18 nonunions healed. The union rate was 90.0% with an average union period of 4.9 months (range, 4-7 months). No deep infection or malunion was found. The two patients with persistent nonunions were advised to use a walker whenever necessary. The satisfactory rate for knee function improved from 0% preoperatively to 80.0% at the latest follow-up. The described technique may concomitantly provide sufficient stability and initiate osteogenic potential, thus facilitating bone union. This technique is simple with a low complication rate and thus should be considered as a useful alternative for treating this complex lesion.