Civilian Ballistic Distal Femur Intraarticular Fracture Patterns.

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Abstract

[Indexed for MEDLINE] 11. J Orthop Trauma. 2025 Nov 1;39(11):621-628. doi: 10.1097/BOT.0000000000003047. Outcomes of Nonunion Repair for Distal Femur Fracture. Roddy E(1), Davis K, Wilson P, Kleweno C, Dunbar RP, Barei D. Author information: (1)Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA. OBJECTIVES: To report the outcomes of aseptic distal femur nonunion repair and to identify factors associated with recalcitrant nonunion. DESIGN: Retrospective cohort study. SETTING: Single academic level 1 trauma center. PATIENT SELECTION CRITERIA: All skeletally mature patients undergoing repair of a presumed aseptic distal femur nonunion (AO/OTA 33A or 33C) between 2005 and 2023 were eligible for inclusion. OUTCOME MEASURES AND COMPARISONS: The primary outcome was the success of the initial nonunion repair attempt. Univariate and multivariable analysis was used to examine patient, injury, and treatment factors associated with recalcitrant nonunion. RESULTS: One hundred and two patients were included. Their average age was 56 years (SD 15) and 64 were female. Forty-seven patients had open fractures and 60 patients had high energy mechanisms. Fifty three fractures were AO/OTA type 33A, while 49 were type 33C. The rate of recalcitrant nonunion was 23%. Diagnosis of fracture-related infection (FRI) after the index nonunion repair was associated with increased risk of recalcitrant nonunion (47% with FRI vs. 18% without FRI, P = 0.021). Nonunion repair with a nail-plate combination was significantly associated with decreased risk of recalcitrant nonunion (0/27, 0%) compared with repair with plate alone (8/28, 29%), nail alone (4/10, 40%), or graft alone (9/25, 36%), P < 0.001. Looking at dual column fixation constructs as a whole (including nail + plate, plate + endosteal plate or medial strut, dual-plate), fixation with a dual column construct was again associated with a lower rate of recalcitrant nonunion (1/36, 3%) compared with nail alone (4/10, 40%), plate alone (8/28, 29%), or graft alone (9/25, 36%), P < 0.001. CONCLUSIONS: Approximately 1 in 4 patients developed a recalcitrant nonunion after attempted nonunion repair. Fixation with a dual column construct was associated with decreased risk of recalcitrant nonunion. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/BOT.0000000000003047