{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:10:18Z","timestamp":1793211018351,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T00:00:00Z","timestamp":1754784000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T00:00:00Z","timestamp":1754784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Orthop Surg Traumatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>There is limited evidence to guide treatment strategies for native and periprosthetic distal femoral nonunions. The aim was to determine factors associated with failure of distal femoral nonunion repair.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adult patients undergoing operative repair for a distal femoral nonunion from 2004 to 2023 at two Level 1 Trauma Centers with\u2009\u2265\u20096\u00a0months follow-up were identified. The primary outcome was additional nonunion surgery. Univariate logistic regression was performed to determine associations of patient, initial fracture,\u00a0nonunion, and treatment characteristics with additional nonunion surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eighty-six patients (median age 63\u00a0years, 63% female) were included. Definitive fixation was most often a non-augmented lateral locking plate (LLP, 52%), 95-degree-blade-plate (BP, 29%), or augmented LLP (15%). Augmented fixation was defined as the addition of a medial or endosteal plate or intramedullary nail. Fourteen patients (16%) required additional nonunion surgery. In univariate logistic regression analysis, initial high-energy injuries (OR: 4.18, p\u2009=\u20090.044), increasing number of previous surgeries (OR: 1.94, p\u2009=\u20090.007), and treatment with retention of previous implants (OR: 5.25, p\u2009=\u20090.010) or bone morphogenetic protein use (OR: 5.82, p\u2009=\u20090.005) were associated with increased odds of additional nonunion surgery; whereas treatment with BP constructs (vs. non-augmented LLPs, OR: 0.11, p\u2009=\u20090.044) reduced odds. Rates of additional nonunion surgery were 12\/45 (27%) for non-augmented LLP, 1\/13 (7.7%) for augmented LLP, and 1\/25 (4.0%) for BP constructs. When excluding patients treated with retention of previous implants, rates were 7\/35 (20%) for non-augmented LLP, 0\/8 (0%) for augmented LLP, and 1\/25 (4%) for BP constructs. There were differences across constructs, including for rates of initial intra-articular fractures (49% vs. 0% vs. 13%), and use of autograft (51% vs. 62% vs. 16%) and bone morphogenetic protein (44% vs. 31% vs. 8.0%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately 1 in 6 patients required additional nonunion surgery. In unadjusted analyses, initial high-energy injuries and more prior surgeries were associated with increased odds for additional nonunion surgery, suggesting that the severity of the initial injury is associated with subsequent nonunion treatment outcomes. The current study findings suggest that distal femoral nonunion repair should be based on revision fixation using augmented lateral locking plate (dual-plate or nail-plate) or blade plate constructs. However, these findings are based on unadjusted comparisons. Larger studies with sufficient power to correct or stratify for confounding are needed to further define optimal treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00590-025-04460-9","type":"journal-article","created":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T06:44:38Z","timestamp":1754808278000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Risk factors for failure of distal femoral nonunion repair"],"prefix":"10.1007","volume":"35","author":[{"given":"Robert K.","family":"Wagner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jochem H.","family":"Raats","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noa H. 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Robert K. Wagner receives financial support from the Marti-Keuning Eckhardt Foundation (Amsterdam, the Netherlands), the Cultuurfonds (Amsterdam, the Netherlands), the VSB Foundation (Utrecht, the Netherlands), and The Prof. Micha\u00ebl-van Vloten Foundation (the Hague, the Netherlands). Thuan V. Ly reports honoraria from the AO Foundation and is a board or committee member for the Orthopaedic Trauma Association. Michael J. Weaver received royalties from OsteoCentric. The remaining authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"343"}}