Analyze The Reasons Of Nonunion Of The Distal Femur Bone Fracture And Relevant Clinical Research

Objective:With the rapid development of society, the production and means oftransport continues to progress,More and more high-energy injuries occur indistal femur.Due to the special anatomical relationship of this site,it becomesone of the most difficult fractures to treat.Although the current level ofmedical and surgical procedures have improved significantly, there is agrowing trend on the femoral condyle nonunion.Through the nonunion casesof distal femur comminuted fractures especially the cases of type C3wereretrospectively analyzed, to explore the related factors affecting the fracturehealing. We hope to make certain theoretical guidance and reduce theprobability of bone nonunion to the first operation of distal femurcomminuted fractures, especially type C3bone fracture, which has higherrates of bone nonunion in clinical treatment.Method:A retrospective study was done,from May2011to December2013,24cases of bone nonunion of distal femoral fractures were treated in thedepartment of trauma in China-Japan Union Hospital of Jilin University,.Among them,15cases of male,9cases of female, the ages range from27years to68years.and the average age is38.2years. In order to know the riskfactors affecting bone healing,mang aspects such as cause of injury, ages, fracture classification, the extent of soft tissue injury, and whether combinedblood vessels and nerve injury，exudate of postoperative wound,the type ofnonunion, manners of fixation and whether performing the bone graft in theoperation. Summarize the classification and proportion of the reasons for thedistal femur comminuted fractures, and summarizes the effective measuresused in the second operation,and provide the reference for the clinic.Andeffective measures can be taken to prevent the occurrence of nonunion whenwe encounter the similar fractures in the future clinical work.Results:In the24cases,bone nonunion because of traffic accidents were got in13cases (54.2%); open fractures were17cases (70.8%); the type C3distalfemur fracture, according to AO classification, were11cases (45.8%); moreexudate of postoperative wound were14cases; Performing the Double steelplate inner fixation due to the type C3distal femur fracture were5cases(20.8%)，and for the type of nonunion, there are12cases of atrophicnonunion(66.7%).Conclusion:There are many reasons can lead to bone nonunion of distal femoralfractures after fixation surgery.1、The main reason of nonunion of distal femoral fractures is the highenergy injury caused by traffic accidents.2、The type C3fractures occur higher rate of bone nonunion in the distal femoral fractures, and relate to the degree of the soft tissue injury andespecially associated with blood vessels,and nerve injury. The more severesoft tissue injury, the more complex fractures, nonunion is significantlyincreased，it may be caused by the blood circulation disorder of the fracture.3、Bone graft is essential in the first operation to the cases of the distalfemur fractures with severe comminuted fractures and bony defects,especially the type C3fracture. For the open fractures, we can make bonegraft after effective debridement and the premise of rational use ofantibiotics.The cases with significant bone defects should be performed bonegraft in the first operation.4、The distal femur comminuted fractures, particular to the type C3fracture, should be used the inside and outside plate fixation. It is much betterto add the inside plate to fixation in the situations when performed to bonegraft and bone defects in inside. It can enhance the effects of support andfixation.5、Exudate from postoperative wound is detrimental to fracture healing.