Management of Distal Femoral Nonunions

The surgical strategy for the patient with distal femur nonunion needs to be individualized respecting both host and injury-related factors. Prehabilitation prior to nonunion reconstruction is essential, focusing on optimization of general health, nutrition, and cessation of negative social behaviors. Surgical tactic is dictated by the type of nonunion and previous surgical method. Considerations should include enhancing both the mechanical and biological environment towards bone union and ultimate functionality. Strategies include addition of medial plate to existing laterally based hardware, plating over pre-existing intramedullary nail, exchange nail, and thin wire fixation. Revision internal fixation with or without bone grafting is preferable while arthroplasty, specifically distal femoral replacement has a role in the more infirm patient