Distal femur nonunion treated with retrograde intramedullary nailing and RIA: a case report

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Francesco Pogliacomi
Carlotta Artoni
Filippo Calderazzi
Massimiliano Leigheb
Paolo Primiceri
Alessio Pedrazzini
Francesco Ceccarelli
Enrico Vaienti


distal femur, fracture, nonunion, fixation, plating, nailing


The current treatment of distal femur fractures includes locking plating and retrograde intramedullary
nailing. These fractures are difficult to manage also for experienced surgeons, with results not always
satisfactory. Reported nonunion rates now range from 0 to 34%. Factors associated with nonunion include
comorbidities, such as obesity and diabetes, as well as the presence of open fractures, medial bone defects
and comminuted fractures. This case report summarizes all of these assumptions and it concerns a 58 years
old patient who underwent to 6 surgical procedures before to arrive to bone healing.


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1. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. Review. J Am Acad Orthop Surg 2010; 18(10): 597-607.

2. Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury 2000 Sep; 31 Suppl 3: C62-3.

3. Santolini E, West R, Giannoudis PV. Risk factors for long bone fracture non-union: a stratification approach based on the level of the existing scientific evidence. Injury 2015 Dec; 46 Suppl 8: S8-S19.

4. Gangavalli AK, Nwachuku CO. Management of Distal Femur Fractures in Adults: An Overview of Options. Orthop Clin North Am 2016 Jan; 47(1) :85-96.

5. Saka N, Watanabe Y, Sasaki G, Kawano H. Corrective Intra-Articular Osteotomy Using a 3D-Printed Model and Induced Membrane Technique for AO/OTA C3 Distal Femur Fracture with Articular Malunion and Metaphyseal Nonunion. Case Rep Orthop 2020 Jan 28; 2020: 1250231.

6. Sain A, Sharma V, Farooque KVM, Pattabiraman K. Dual Plating of the Distal Femur: Indications and Surgical Techniques. Cureus. 2019 Dec 27; 11(12): e6483.

7. Kiyono M, Noda T, Nagano H, Maehara T, Yamakawa Y, Mochizuki Y, Uchino T, Yokoo S, Demiya K, Saiga K, Shimamura Y, Ozaki T. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. J Orthop Surg Res 2019 Nov 26; 14(1): 384.

8. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013 May;99(3):353–60.

9. Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am 2007 Oct ; 89 (10): 2298-307.

10. Meneghini RM, Keyes BJ, Reddy KK, Maar DC. Modern retrogradeintramedullary nails versus periarticular locked plates for supracondylarfemur fractures after total knee arthroplasty. J Arthroplasty 2014; 29: 1478-81.

11. Ebraheim NA, Kelley LH, Liu X, Thomas IS, Steiner RB, Liu J. Periprostheticdistal femur fracture after total knee arthroplasty: a systematic review, Orthop Surg 2015; 7(4): 29-305.

12. N.F. Matlovich, B.A. Lanting, E.M. Vasarhelyi, D.D. Naudie, R.W. McCalden, J.L.Howard, Outcomes of surgical management of supracondylar periprostheticfemur fractures, J. Arthroplasty 32 (2017) 189–192.

13. Ristevsk BI, Nauth A, Williams DS, Hall JA, D.B. Whelan DB, Bhandari M, Schemitsch EH. Systematic review of the treatment of periprosthetic distal femurfractures, J. Orthop Trauma 2014; 28: 307-12.

14. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 2014 Feb; 28 (2): 83-9.

15. Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma 2006 May; 20(5): 366-71.

16. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury 2003 Nov; 34 (Suppl 2): B63–76.

17. Bosetti M, Borrone A, Leigheb M, Shastri VP, Cannas M. Injectable Graft Substitute Active on Bone Tissue Regeneration. Tissue Eng Part A. 2017 Dec, Vol.23, N.23-24: 1413-1422 doi: 10.1089/ten.tea.2016.0554

18. Bosetti M, Leigheb M, Boccafoschi F, Brooks R, Cannas M. Regulation of osteoblast and osteoclast functions by FGF-6. J Cell Physiol. 2010 Nov;225(2):466-71.

19. Bosetti M, Boccafoschi F, Leigheb M, Cannas M. Effect of different growth factors on human osteoblasts activities: a possible application in bone regeneration for tissue engineering. Biomol Eng. 2007 Dec.; 24(6): 613-618. [I.F. 4,3]

20. Kim K. Usefulness of bilateral plate fixation for periprosthetic distal femur fracture after total knee arthroplasty. Int J Surg Case Rep. 2020 Feb 6; 68: 43-7.

21. Ryan JA, Meyers KN, Dibenedetto P, Wright TM, Haas SB. Failure of the Patellar Tendon with the Patella Everted versus Noneverted in a Matched-Pair Cadaver Model. HSS J. 2010 Sep; 6(2): 134-7.

22. Frattini M, Vaienti E, Soncini G, Pogliacomi F. Tibial plateau fractures in elderly patients. Chir Organi Mov 2009; 93: 109-14.

23. Pogliacomi F, Verdano MA, Frattini M, Costantino C, Vaienti E, Soncini G. Combined arthroscopic and radioscopic management of tibial plateau fractures: Report of 18 clinical cases. Acta Biomed 2005; 76: 107-14.

24. Vaienti E., Scita G., Ceccarelli F, Pogliacomi F. Understanding the human knee and its relationship to total knee replacement. Acta Biomed 2017 Jun 7; 88(2 -S): 6-16.

25. Leigheb M, Pogliacomi F, Bosetti M, Boccafoschi F, Sabbatini M, Cannas M, Grassi F. Postoperative blood salvage versus allogeneic blood transfusion in total knee and hip arthroplasty: a literature review. Acta Biomed 2016; 87 (Suppl 1): 6-14.

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