Retrograde Dynamic Locked Nailing for Femoral Supracondylar Nonunions After Plating

Background: No surgical procedure has clearly proven superior in treating femoral supracondylar nonunions after plating. All traditional devices have limitations. A technique for improving the approach of retrograde locked nailing to increase a success rate was developed. Methods: Twenty-one consecutive adult patients with 21 femoral supracondylar nonunions after plating were treated by lateral approach. Soft-tissue detachment was minimized as much as possible. Retrograde dynamic locked nailing and cancellous bone grafting were consequently performed. Postoperatively, protected weight bearing with exercise of knee range of motion was encouraged as early as possible. Results: Eighteen patients were followed up for an average of 3.3 years (range, 1.2-6.5 years). Sixteen nonunions healed with a union rate of 88.9% and an average union period of 4.2 months (range, 3.5-5.0 months). Although two nonunions persisted without further treatment because of patient hesitation, all patients achieved satisfactory functional outcome. Conclusion: Although neither surgical technique is clearly superior for treating femoral supracondylar nonunions after plating, the lateral approach with retrograde dynamic locked nailing and cancellous bone grafting may prove to be the optimal treatment alternatives. Minimizing soft-tissue destruction during surgery in addition to protected weight bearing through the treatment course may effectively raise the success rate.