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Fixed-angle plate fixation and autogenous iliac crest graft for repair of distal metaphyseal femoral nonunion

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

To analyze clinical, radiographic and patient-reported outcomes of distal metaphyseal femoral nonunions treated with fixed-angle plates and screws.

Methods

All patients presenting with a distal metaphyseal femoral fracture nonunion repaired with fixed-angle plating from one urban level 1 trauma center and an orthopedic specialty hospital were identified. Baseline demographic, injury information, and outcomes (healing rates, Short Musculoskeletal Function Assessment, range of motion, and post-operative pain levels) at 12 months following nonunion repair were collected. Outcomes were evaluated between patients fixed with a blade plate and with a locking plate.

Results

Of these 31 patients, 27 (87.1%) healed after their index nonunion surgery, 2 (6.5%) healed after one reoperation, 1 (3.2%) healed after 2 reoperations, and 1 (3.2%) had a persistent nonunion but did not want further treatment. At one-year follow-up, the group demonstrated a significant improvement in functional recovery with a mean difference of 14.5 points (p = 0.007) when compared to status before fixed-angle fixation of the nonunion. There was also a significant change in patient-reported pain levels using the VAS scale with a mean difference of 2.0 points (p = 0.009). At one-year follow-up, 11 (39.3%) had full knee range of motion (0–130), 11 (39.3%) had flexion greater than 90 and less than 120°, and 6 (21.4%) had range of motion less than 90°.

Conclusion

Patients who undergo fixed angle plating and autogenous bone grafting for distal femoral metapyseal nonunions demonstrate improved functional outcomes and VAS pain score at one year follow up.

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Authors and Affiliations

  1. Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA

    Emma K. Landes, Sanjit R. Konda, Philipp Leucht, Abhishek Ganta & Kenneth A. Egol

  2. Department of Orthopedic Surgery, Jamaica Hospital Medical Center, 8900 Van Wyck Expressway, Queens, NY, 11418, USA

    Sanjit R. Konda, Abhishek Ganta & Kenneth A. Egol

Authors
  1. Emma K. Landes
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  2. Sanjit R. Konda
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  3. Philipp Leucht
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  4. Abhishek Ganta
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  5. Kenneth A. Egol
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Correspondence to Kenneth A. Egol.

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All authors declare that they have no conflicts of interest related to the contents of this manuscript. Authorship has been granted only to those individuals who have contributed substantially to the research or manuscript. No sources of funding have been granted for this study.

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Landes, E.K., Konda, S.R., Leucht, P. et al. Fixed-angle plate fixation and autogenous iliac crest graft for repair of distal metaphyseal femoral nonunion. Eur J Orthop Surg Traumatol 33, 1835–1839 (2023). https://doi.org/10.1007/s00590-022-03366-0

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