Surgical Treatment of Atrophic Femoral Shaft Nonunion

This review aims to identify the advantages and limitations of the treatment strategies for atrophic femoral nonunion and is based on the analysis of 358 publications (from 1973 to 2025). The literature search was conducted using the PubMed (MEDLINE) and eLibrary databases in accordance with the PRISMA guidelines for systematic reviews. The analysis demonstrated that the majority of the publications consist of single case reports or small case series. No universally accepted standard for the treatment for this condition has been established, and there is insufficient high-quality evidence to support the selection of an optimal treatment strategy. The pathophysiological and pathomorphological characteristics of fracture healing associated with the development of hypertrophic and atrophic nonunion suggest that the preferred treatment is excision of the nonunion, followed by single-stage reconstruction with autologous bone grafting and achievement of absolute mechanical stability, including through combined osteosynthesis.