The use of the 95-degree-angled blade plate in femoral nonunion surgery

Introduction: The 95-degree-fixed angle blade plate has been in use for decades for both acute femoral fractures and nonunions. Our objective was to examine the results of use by a single surgeon of the 95-degree-angled blade plate in proximal and distal femoral nonunion surgery. Patients and methods: The nonunion database of a single surgeon over a 16 year period was used to identify all proximal and distal femoral nonunions that were treated with open reduction and internal fixation using the 95-degree-angled blade plate. There were 78 cases in which the blade plate was used, and 68 of 78 (87.2 % follow-up rate) were followed to a final outcome, which was defined as complete healing of the nonunion, conversion to arthroplasty, or amputation. Failure was defined as revision surgery for persistence of nonunion, conversion to arthroplasty prior to healing, or amputation. Three patients who failed were lost to follow-up prior to a final outcome. Results: In the 71 patients who were followed to failure or complete follow-up, the rate of healing with one surgery was 77.5 % (55 of 71). Eight of 16 failures required a second surgery for persistence of nonunion and eventually went on to heal the nonunion. Eleven of the 16 failures were in patients who had a known infected nonunion. When the 21 cases of infected nonunions were excluded, the healing rate for aseptic nonunions with one surgery alone using the 95-degree-angled blade plate was 91.2 % (52 of 57) compared with 47.6% (10 of 21) in the infected nonunion group (p<0.0001). Eleven patients who had healed their nonunion underwent all or partial removal of the implant for irritation or prominence. Conclusion: The 95-degree-angled blade plate is an effective reduction aid and fixation device for aseptic nonunions of the proximal and distal femur with acceptable healing rates with one surgery alone.