Management of Distal Femoral Non-union: A Systematic Review

IntroductionManaging distal femur fracture nonunion is complex, with unpredictable results. The present investigation systematically updates current evidence, reviews existing modalities, innovations and related outcomes, and discusses future perspectives on the management of nonunion of the distal femur.MethodsThis study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. In April 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed without time constraints. No additional filters were used in the database search. All the clinical studies investigating treatment options for nonunion of distal femur fractures were accessed.Results35 clinical studies (832 patients) were included. Of them, 34.2% (239 of 698 patients) reported an open fracture, and 24.5% (78 of 319 patients) reported infection at the fracture site. The mean length of the follow-up was 28.9 +/- 13.2 months. The mean age of the patients was 53.8 +/- 14.7 years.Conclusion84.5% (703 of 832) of patients reached complete union without major complications, and 3.8% (32 of 832) reached complete union with major complications at a mean of 21.7 +/- 20.9 months. 8.7% (72 of 832) patients showed signs of persistent non-union.Level of evidenceLevel III, systematic review.