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J Am Acad Orthop Surg, Vol 16, No 2, February 2008, 88-97.
© 2008 the American Academy of Orthopaedic Surgeons
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Femoral Nonunion: Risk Factors and Treatment Options

Joseph R. Lynch, MD, Lisa A. Taitsman, MD, MPH, David P. Barei, MD and Sean E. Nork, MD

Dr. Lynch is Fellow and Acting Instructor, Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine, Seattle, WA. Dr. Taitsman is Assistant Professor, Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine. Dr. Barei is Associate Professor, Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine. Dr. Nork is Associate Professor, Department of Orthopaedics and Sports Medicine, University of Washington School of Medicine.

None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lynch, Dr. Taitsman, Dr. Barei, and Dr. Nork.

Reprint requests: Dr. Lynch, Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Box 356500, 1959 NE Pacific Street, Seattle, WA 98195.

Despite advances in surgical technique, fracture fixation alternatives, and adjuncts to healing, femoral nonunion continues to be a significant clinical problem. Femoral fractures may fail to unite because of the severity of the injury, damage to the surrounding soft tissues, inadequate initial fixation, and demographic characteristics of the patient, including nicotine use, advanced age, and medical comorbidities. Femoral nonunion is a functional and economical challenge for the patient, as well as a treatment dilemma for the surgeon. Surgeons should understand the various treatment alternatives and their role in achieving the goals of deformity correction, infection management, and optimization of muscle strength and rehabilitation. Used appropriately, nail dynamization, exchange nailing, and plate osteosynthesis can help minimize pain and disability by promoting osseous union. A review of the potential risk factors and treatment alternatives should provide insight into the etiology and required treatment of femoral nonunion.






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Copyright © 2008 by the American Academy of Orthopaedic Surgeons.