Surgical nonunion treatment of large-sized defects of femur and tibia based on the diamond concept
2025

Surgical Treatment of Large-Sized Nonunions in Femur and Tibia

Sample size: 70 publication Evidence: moderate

Author Information

Author(s): Sebastian Findeisen, Louis Mennerat, Thomas Ferbert, Lars Helbig, Tim N. Bewersdorf, Tobias Großner, Christian Schamberger, Gerhard Schmidmaier, Michael Tanner

Primary Institution: Clinic for Trauma and Reconstructive Surgery, Centre for Orthopedics, Trauma Surgery, and Paraplegiology, Heidelberg, Germany

Hypothesis

The study aims to evaluate the radiological outcome of patients with large bone defects in the femur and tibia treated according to the diamond concept.

Conclusion

A structured follow-up of at least two years is necessary to confirm the consolidation of large-sized nonunions, as many patients may show healing in the second year.

Supporting Evidence

  • 64.3% of patients achieved consolidation of their nonunion within two years.
  • The mean defect size was 6.77 cm, with the largest being 12.6 cm.
  • Patients with tibial nonunions had a higher rate of postoperative infections.
  • Smoking and diabetes were identified as risk factors for nonunion.
  • Follow-up of at least two years is necessary for accurate assessment of healing.

Takeaway

Doctors need to check on patients with big bone breaks for at least two years to see if they heal properly, because some might take longer than expected.

Methodology

This was a retrospective, descriptive analysis of patients treated for nonunions from January 2010 to December 2021, focusing on radiological consolidation outcomes.

Limitations

A significant number of patients were lost to follow-up, and the study was retrospective, limiting the ability to conduct randomized trials.

Participant Demographics

{"mean_age":58.64,"sex_distribution":{"male":50,"female":20}}

Digital Object Identifier (DOI)

10.1302/2633-1462.61.BJO-2024-0096.R1

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