Management and Surgical Optimization of Failed Distal Femur Fractures

Distal femur fractures present a particularly complex problem to surgeons at all levels of experience. Concerns that arise for treating surgeons include determining the optimal fixation strategy based on the patient's biology, as well as determining the optimal surgical approach to decrease perioperative morbidity. As the risk for nonunion is high in distal femur fractures, surgeons must be aware of the available options to achieve stable fixation and ultimately bony union. A multitude of techniques exist for treating distal femoral nonunion. These techniques range from revision open reduction internal fixation, plate augmentation with a medial femur plate, a nail-plate combination, and a distal femur replacement when appropriate. This article will review the literature and include radiographic case examples of several fixation strategies in the treatment of distal femoral nonunions.