Plate osteosynthesis and allograft augmentation in pseudarthrosis of the femur

Introduction : Femoral nonunion remains a challenging complication, particularly in elderly patients with osteoporosis, failed previous fixation, or impaired bone biology. Plate osteosynthesis combined with endosteal augmentation using a frozen fibular allograft may improve construct stability and biological support. This study evaluated the clinical and radiographic outcomes of this technique in patients with femoral nonunion. Methods : We retrospectively reviewed eight patients with femoral nonunion treated between 2013 and 2023. The mean age was 67.5 years (range, 49–87). Revision surgery included implant removal when required, debridement, Judet decortication, plate fixation, and intramedullary augmentation with a frozen fibular allograft. Clinical and radiographic union, time to union, complications, limb-length discrepancy, pain, and functional outcomes were assessed. Results : Union following the initial revision procedure was achieved in seven of eight patients (87.5%), with a mean time to union of 12 months (range, 5–27). The remaining patient achieved union seven months after additional medial plating and iliac crest bone grafting. Partial weight-bearing was initiated immediately after surgery in all patients. The mean Harris Hip Score was 87, the mean Lysholm Knee Score was 86, and the mean visual analogue scale pain score was 3. Mean limb-length discrepancy was 5 mm (range, 0–7). No postoperative infections occurred. One fibular graft fractured during insertion. Conclusion : Plate osteosynthesis with endosteal frozen fibular allograft augmentation may provide useful mechanical and biological support in selected complex femoral nonunions, particularly in osteoporotic bone. However, the small and heterogeneous cohort limits definitive conclusions, and larger comparative studies are required.