One-Stage Lengthening Using a Locked Nailing Technique for Distal Femoral Shaft Nonunions Associated With Shortening

Objective To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. Design Retrospective. Setting University hospital. Patients and Methods During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5–5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by ≤4 cm aided by a laminar spreader, insertion of a static locked nail, and grafting of corticocancellous bone. Mize's classification for clinical function was used for final patient evaluation. Results A total of 32 nonunions were followed-up for at least 1 year (median 3.8 years; range 1.2–6.9 years), and 29 fractures healed. The median union period was 4.5 months (range 3–6 months). Three fractures persistently failed to heal. One was treated successfully with exchange nailing, and the remaining two patients were followed annually and had no symptoms. At the latest follow-up, all 32 patients had achieved a satisfactory outcome. The average lengthening was 2.5 cm (range 1.5–3.5 cm). Conclusions One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.