ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
What is the rate and degree of deformity in femoral diaphyseal nonunion? A CT-based retrospective cohort study.
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study investigated the rate and degree of deformity in femoral diaphyseal nonunion using preoperative bilateral CT-scans.
methodsA retrospective cohort study was conducted at a single Level 1 trauma center. Patients aged > 18 years who underwent operative treatment for femoral diaphyseal nonunion between 2015 and 2025 and had preoperative bilateral femur CT-scans were included. Axial, sagittal, coronal, and length differences between the femoral nonunion and the contralateral healthy femur were measured. Torsional deformity ≥ 15° and length discrepancy ≥ 20 mm were considered clinically relevant. Thresholds of ≥ 5° and ≥ 10° were used to identify outliers in coronal and sagittal plane deformity, respectively.
resultsThirty-two patients met the inclusion criteria (median age 57 years, 63% male). Torsional deformity ≥ 15° was present in 10 patients (31%), including internal rotation in 4 (13%) and external rotation in 6 (19%). Sagittal plane deformity ≥ 10° was observed in 5 patients (16%), with apex anterior angulation in 1 (3%) and apex posterior angulation in 4 (13%). Mean sagittal plane angulation was 9.7° ± 6.7° in the affected limb and 12.5° ± 2.6° in the unaffected limb (p = 0.017). Coronal plane deformity ≥ 5° was present in 10 patients (31%), including varus in 8 (25%) and valgus in 2 (6%). Mean coronal angulation was 5.3° ± 6.0° in the affected limb and 3.3° ± 2.5° in the unaffected limb (p = 0.099). Mean femoral length was 439 ± 31 mm in the affected limb and 445 ± 28 mm in the unaffected limb (p = 0.015), with a length discrepancy ≥ 20 mm in 5 patients (16%).
conclusionsClinically relevant torsional deformity was present in one in three patients undergoing femoral shaft nonunion surgery, while femoral length discrepancy ≥ 20 mm occurred in one in six. A small but significant decrease in apex anterior angulation was observed, and most coronal plane outliers were in varus. These findings underline the importance of recognizing deformity in femoral nonunion.
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