Successful Reconstruction for Complex Malunions and Nonunions of the Tibia and Femur

Background: Information regarding the long-term outcomes of the treatment of lower-extremity fracture malunion and nonunion is lacking. Methods: Twenty-nine secondarily referred patients with complex malunion or nonunion of the tibia or femur, treated by a single surgeon, were followed for a median of twenty years (range, twelve to thirty-five years) after injury. The patients were referred at a median of twenty months (range, 1.5 to 360 months) postinjury and had undergone a median of three prior surgical procedures (range, zero to twenty-eight). At the time of final follow-up, patient-based outcomes, patient satisfaction, and pain were evaluated. Results: All twenty-nine patients had healing following treatment of the complex malunion or nonunion of the tibia or femur and were able to bear full weight and walk one block or more. The Lower Extremity Functional Scale (LEES) outcome tool revealed that twenty patients (69%) experienced moderate-to-severe difficulties in carrying out activities because of their lower-limb disability. The median Short Form-36 (SF-36) score was 67, with a median physical component score of 61 and a median mental component score of 71, indicating substantial impact on physical health status when compared with the norm. Conclusions: Reconstruction can be a worthwhile endeavor and should be considered for all patients with complex malunion or nonunion of the tibia or femur.