Results of Treatment of 111 Patients With Nonunion of Femoral Shaft Fractures

The purpose of this study is to report our experience with the treatment of femoral shaft fracture nonunion and to define poor prognostic indicators in the treatment of this complication. The records and available radiographs of 111 patients treated for nonunion of the femoral shaft in our institution were retrospectively reviewed. The mean duration of follow-up after establishment of nonunion was 62 months. The following factors were found to have an adverse effect on nonunion healing (p < 0.05): (1) advanced patient age; (2) presence of osteomyelitis; (3) presence of synovial pseudarthrosis; (4) duration of nonunion; (5) treatment with flexible intramedullary devices; (6) treatment with compression plating; (7) poor bone stock; (8) malalignment in the anteroposterior plane of more than 10 degrees; and (9) malalignment in the lateral plane of more than 20 degrees.