Malunions of the Distal Femur

Distal femur fractures represent a common complex traumatic pathology fraught with potential complications and reoperation rates in excess of 15%. In the course of treatment of distal femur fractures, eventual malunion complications can occur from iatrogenic causes, implant failure, patient noncompliance, or from the original severe fracture morphology. The best treatment for a malunion is prevention of an index malreduction. This requires technical brilliance and employment of several various strategies which can help reduce their incidence, but occurrence remains possible. When dealing with malunions, early identification, recognition, and quantification of deformity are the keys to preventing further debilitation and potential joint destruction. Patient considerations and extensive counseling must be carefully navigated for the appropriate treatment strategy to be selected. Methods for correction depend largely on the plane(s) and severity of deformity, but also on patient demographics, comorbidities, and biology. Options for correction include varying types of osteotomies – uniplanar, biplanar, or double oblique – combined with internal fixation or combined with osteoplasty in the method of Ilizarov. Fixation depends on the type of strategy employed but can be done with plating, intramedullary nailing, or external fixation.