Augmentative locking plate with autologous bone grafting for distalfemoral nonunion subsequent to failed retrograde intramedullary nailing

Abstract

Objective: To explore the indications and efŞcacy of augmentative locking compression plate (LCP) or lessinvasive stabilization system (LISS)with autogenous bone grafting (BG) in treating distal femoralnonunion subsequent to failed retrograde intramedullary nailing (RIN).Methods: A retrospective study was performed for 21 patients with distal femoral nonunion subsequentto failed RIN, who received therapy with either augmentative LCP (n¼ 11) or LISS with autogenous BG(n¼ 13). Operation time, time to union, union rate, time to renonunion, complication rate and SF-36scores a year after hardware removal were compared between the two groups.Results: The bone union occurred in 13/13 (100%) cases in augmentative LISS group versus 9/11 (81.8%)cases in augmentative LCP group [odds ratio (OR)¼ 3.21, 95% conŞdence interval (CI) 0.7e13]. Time tounion, time to renonunion, complication rate of the augmentative LCP group were signiŞcantly morethan that of the augmentative LISS with autogenous BG group (p¼ 0.023, p ¼ 0.021 and p ¼ 0.033). NosigniŞcant difference was found in the average operation time of two groups (p ¼ 0.121). At the follow-upa year after hardware removal, statistically signiŞcant HRQOL improvement in the augmentive LISS groupwas measured at the level of pain (p¼ 0.003) and general health perception (p ¼ 0.011), as compared tothe augmentive LCP group.Conclusions: We suggest augmentative LCP, for distal femoral nonunios after RIN, may be optimal for thatof typeAO33A fractures, whereas augmentative LISS for that of typeAO33C fractures more.© 2016 Turkish Association of Orthopaedics and Traumatology. Publishing services by Elsevier B.V. This isan open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)