Exchange Nailing for Aseptic Nonunion of the Femoral Shaft after Intramedullary Nailing

( Sung-soo Ha ),( Chang-wug Oh ),( Jae-wook Jung ),( Joon-woo Kim ),( Kyeong-hyeon Park ),( Seong-min Kim ) 대한외상학회 2020 大韓外傷學會誌 Vol.33 No.2

Purpose: Although exchange nailing is a standard method of treating femoral shaft nonunion, various rates of healing, ranging from 72% to 100%, have been reported. The purpose of this study was to evaluate the efficacy of exchange nailing in femoral shaft nonunion. Methods: We retrospectively reviewed 30 cases of aseptic femoral shaft nonunion after intramedullary nailing. The mean postsurgical period of nonunion was 66.8 weeks. A nail at least 2 mm larger in diameter was selected to replace the previous nail after reaming. Distal fixation was performed using at least two interlocking screws. The success of the procedure was determined by the finding of union on simple radiographs. Possible reasons for failure were analyzed, including the location of nonunion, the type of nonunion, and the number of screws used for distal fixation. Results: Of the 30 cases, 27 achieved primary healing with the technique of exchange nailing. The average time to achieve union was 23.1 weeks (range, 13.7-36.9 weeks). The three failures involved nonunion at the isthmic level (three of 15 cases), not at the infraisthmic level (zero of 15 cases). Of eight cases of oligotrophic nonunion, two (25%) failed to heal, and of 22 cases of hypertrophic nonunion, one (4.5%) failed to heal. Of 11 cases involving two screws at the distal fixation, two (18.2%) failed to heal, and of 19 cases involving three or more screws, one (5.3%) failed to heal. None of these findings was statistically significant. Conclusions: Exchange nailing may enable successful healing in cases of aseptic nonunion of the femoral shaft. Although nonunion at the isthmic level, oligotrophic nonunion, and weaker distal fixation seemed to be associated with a higher chance of failure, further study is needed to confirm those findings.

요추부 후외방 유합술 후 수술적 치료를 요하는 불 유합의 위험 인자

하임식,이규열,손성근,정일권,선상규 대한척추외과학회 2010 대한척추외과학회지 Vol.17 No.2

Study Design: This is a retrospective study for radiographically and clinically assessing nonunion after lumbar spine fusion. Objectives: We wanted to analyze the risk factors for nonunion that requires surgical treatment after lumbar spine fusion Summary of the Literature Review: A diagnosis of the nonunion after lumbar spine fusion was made by using only the only radiologic images. The incidence of nonunion has been underreported because there are many asymptomatic patients. Materials and Methods: The plain X-ray films were evaluated for 1317 patients who could be followed up more than 1 year after lumbar fusion. Nonunion was diagnosed at 1 year after fusion by instability seen on the flexion-extension radiograph and the clinical findings like as sustained pain and local tenderness at the surgical site. The risk factors we reviewed included age, the number of levels fused, associated diseases, smoking, alcohol drinking, the initial diagnosis, a previous history of spinal operation, infection, a clear zone and malposition of pedicle screws and metal failure. The relations between nonunion and the factors mentioned above were analyzed. Results: Thirty-nine patients were diagnosed as having nonunion underwent reoperation and all had surgically confirmed nonunion. Smoking, infection and a previous history of spine operation had a significant influence on nonunion (p < 0.05). Clear zones persisting more than 1 year and metal failure also had a significant influence on nonunion (p < 0.05). Age, the number of fused levels, the initial diagnosis and alcohol drinking were not shown to influence the rate of nonunion (p < 0.05). Conclusion: A through clinical and radiologic evaluation is essential to diagnose nonunion, and this should not be done according to the radiologic images only. Risk factors such as a previous history of spine operation, infection, smoking, the development of a clear zone and metal failure all showed a statistically significant influence on nonunion. Additionally, preoperative and postoperative evaluation of these parameters is needed to achieve bone union. 연구 계획: 요추부 후외방 유합술 후 수술적 치료를 요하는 불유합에 대한 후향적 연구목적: 본 연구는 요추부 후외방 유합술 후 발생한 불유합으로 재수술을 시행한 환자들을 대상으로 불유합과 관련된 위험 인자를 분석하여 보고하고자한다. 선행 문헌의 요약: 요추부 유합술 후 불유합의 진단은 방사선 사진만으로 평가되어져 왔다. 불유합의 발생율은 많은 무증상 환자들로 인해 적게 보고되고 있는 실정이다. 대상 및 방법: 요추부의 후외방 유합술을 시행 받고 1년 이상 추시 관찰이 가능했던 1317명을 대상으로 방사선 사진을 분석하였다. 불유합은 유합술 시행 1년 후 굴곡 신전 방사선 검사상 추체간의 움직임 및 수술 부위의 국소 동통과 통증이 동반되는 경우로 정의하였다. 불유합으로 진단된 39명에서 재수술을 시행하였고, 불유합과 나이, 수술 받은 척추 분절 수, 동반 질환, 흡연, 음주, 최초 수술시 진단, 이전 척수 수술 여부, 수술 부위 감염, 방사선 투과대 발생, 척추경 나사의 이상 위치 및 금속 실패와의 관련성을 분석하였다. 결과: 재수술을 시행한 39명에서 모두 불유합이 확인되었다. 불유합은 흡연자군, 술 후 감염이 발생한 군 및 척추 수술 과거력이 있는 군에서 더 많았고각각은 통계학적으로 유의하였다(p < 0.05). 그리고 1년째 지속적으로 방사선 투과대 양성인 경우 및 금속 실패와 불유합 발생 간에도 통계학적으로 유의한 결과가 나타났다( p < 0.05). 나이, 수술 받은 척추 분절 수, 진단명, 그리고 음주 간에는 통계학적 유의성이 없었다(p > 0.05). 결론: 기존의 방사선 사진만으로 불유합을 정의하는 것은 제한점이 있어 임상 증상을 진단에 추가하는 것이 바람직할 것으로 생각된다. 또한 이전 척추수술 여부, 감염, 흡연, 방사선 투과대 발생 및 금속 실패 등의 경우에서 불유합 발생률이 유의하게 높았으며, 골유합 획득을 위해 이런 인자들에 대한 술전, 술 후 평가가 충분히 고려되어야 할 것으로 사료된다.

Osteoperiosteal Decortication and Autogenous Cancellous Bone Graft Combined with Bridge Plating for Non-hypertrophic Diaphyseal Nonunion

Youngho Cho,Young-Soo Byun,Jeong-Duk Suh,Junhyug Yoo 대한정형외과학회 2021 Clinics in Orthopedic Surgery Vol.13 No.3

Background: The aim of this study was to evaluate results of osteoperiosteal decortication and autogenous cancellous bone graft combined with a bridge plating technique in atrophic and oligotrophic femoral and tibial diaphyseal nonunion. Methods: We retrospectively reviewed 31 patients with atrophic or oligotrophic femoral and tibial diaphyseal nonunion treated with osteoperiosteal decortication and autogenous cancellous bone graft between January 2008 and December 2018. Patients with hypertrophic nonunion, infected nonunion, and nonunion treated with autogenous cancellous bone graft alone were excluded. The nonunion site was exposed by using the Judet technique of osteoperiosteal decortication. Nonunion with a lack of stability was stabilized with a new plate using a bridge plating technique or augmented by supplemental fixation with a plate. Nonunion with malalignment was stabilized with a new plate after deformity correction. Autogenous cancellous bone graft was harvested from the posterior iliac crest and placed within the area of decortication. A basic demographic survey was conducted, and the type of existing implants, mechanical stability of the implants, the type of implants used for stabilization, the operation time, the time to bone union, and postoperative complications were investigated. Results: The average follow-up period was 33.3 months (range, 8–108 months). The operation time was 207 minutes (range, 100– 351 minutes). All but 1 nonunion (96.7%) were healed at an average of 4.2 months (range, 3–8 months). In 1 patient, bone union failed due to implant loosening with absorbed bone graft, and solid union was achieved by an additional surgery for stable fixation with a new plate, osteoperiosteal decortication, and autogenous cancellous bone graft. There were no other major complications such as neurovascular injuries, infection, loss of fixation, and malunion. Conclusions: Osteoperiosteal decortication and autogenous cancellous bone graft combined with stable fixation by bridge plating showed reliable outcomes in atrophic and oligotrophic diaphyseal nonunion. This treatment modality can be effective for treating atrophic and oligotrophic diaphyseal nonunion because it is very helpful stimulating bone union.

불유합의 원인과 치료

박경현,김준우,오창욱 대한정형외과학회 2018 대한정형외과학회지 Vol.53 No.1

Nonunion is caused by various factors related to fracture characteristics, patient characteristics, treatment, and infection. Aseptic nonunion, is divided into three categories in accordance with the biological activity of the fracture: atrophic nonunion, oligotrophic nonunion, and hypertrophic nonunion. Treatment of nonunion depends on the cause and classification. Here, we report our experiences and review the various causes of nonunion and treatment methods available 불유합은 골절의 특성, 환자의 특성 및 치료 등과 관련된 다양한 인자, 그리고 감염 등의 원인으로 발생한다. 감염성을 제외한 비감염성 불유합은 골절부의 생물학적 활동에 따라 위축성, 빈영양형, 그리고 비후형으로 나뉘게 된다. 불유합의 치료는 그 원인 및 분류에따라 적절한 치료를 하게 된다. 이에 관하여 저자의 경험과 함께 불유합의 원인과 치료 방법에 대해 알아보고자 한.다

쇄골 중간부 골절후 불유합 및 지연 유합의 원인

윤정로,심재익,김택선,이성종,김영배,김학준,안국환,장재영,홍명표 대한골절학회 2002 대한골절학회지 Vol.15 No.4

쇄골 중간 1/3 부위의 골절은 치료 결과가 양호하여 보존적 치료가 원칙적으로 받아 들어지고 잇으며 불유합에 대한 빈도도 낮은 것으로 되어 있다. 그러나 최근 전위 및 단축의 정도가 심할 경우 높은 불유합의 결과와 불량한 임상 결과를 보고하고 있어 이런 예에 대해선 수술적 치료를 권장하고 있다. 저자들은 단축 및 전위의 정도와 불유합의 연관성을 알아보고자 하였다. 연구 대상 및 방법 : 1993년 2월부터 2002년 1월까지 본원에 내원 했던 성인 중간부 쇄골 골절 환자 194명 중 완전 전위를 보인 78례를 조사하여 이중 63례를 대상으로 분석하여 후 향적 연구를 시행하였다. 4개월 추시 후에도 방사성 사진상 유합 소견이 관찰되지 않으면 불유합의 유의성을 알아보고자 하였다. 결 과 : 63례 중 불유합 및 지연 유합을 소견을 보인 환자는 15(23%)례였다. 골유합을 보인 48례의 단축은 평균 8.6㎜(2㎜-17㎜)였고, 전위는 평균 9.7㎜(2-22㎜)였다 .불유합 및 지연 유합을 보였던 15례에서 단축은 평균 14.5㎜(3㎜-37㎜), 전위는 평균 17.3㎜(4-25㎜)였다. 18㎜이상 단축이 있었던 경우 불유합의 발생과는 통계학적으로 유의성을 나타내었고(Fisher's exact test, p<0.01), Chi-square test상 16㎜ 이상의 전위를 보였던 경우 불유합 발생과 통계학적으로 의미가 있었다(p<0.01). 결 론 : 쇄골 골절 특히 중간 1/3의 골절은 비교적 보존적 치료에 결과가 좋은 것으로 되어 있으나, 전위 및 단축이 심한 경우 불유합에 대한 가능성이 높이 때문에 보다 경과 관찰시 유합의 진행이 없으면 적극적인 치료를 고려해야한다. Purpose : Because the prognosis of the mid 1.3 clavicle fracture is good, the conservative treatment with a figure of 8 bandage is the gold standard and the nonunions are rare. However, recently surgical treatment is recommended when the shortening and displacement is severe because of the high nonunion rate and the poor clinical result. This study was undertaken to evaluate that the shortening and displacement at fracture site are associated with the development of nonunion. Materials and Methods : We analysed the 194 fractures of mid 1/3 clavicle in adults which had been treated conservatively from February 1993 to January 2002 and did the retrospective study. Of these, 78 cases were originally in the middle third of the clavicle and had been completely displaced. We reviewed 63 of these cases. The shortening and displacement at the fracture site was measured on the initial roentgenogram. And the analysis of the patients' chart was done for another predisposing nonunion factors. Nonunion and delayed union are considered to be present when there has been little or no progression of clinical or radiographic healing at a minimum of 4 months after injury. Results : 15 of the 63 cases had developed nonunion.. The average 8.6㎜(2㎜-17㎜) shortening and average 9.7㎜(2-22㎜) in the union patients. The average 14.5㎜(3㎜-37㎜) shortening and average 17.3㎜(4-25㎜) in the nonunion patients. We found that initial shortening ≥18㎜(Fisher's exact test, p<0.01) and initial displacement ≥ 16㎜(Chi-square test. p<0.01)at the fracture site were significantly associated with the development of nonunion. Conclusion : The conservative treatment with figure-80-bandage is the gold standard in the clavicle middle one third fracture. However, the nonunion is commonly occurs in the cases of more of severely shortened and displaced fractures. If there are no signs of callus formation and the patient complains of pain after several week, osteosynthesis should be considered.

원위 비골 골절의 수술 후 발생한 불유합의 관련 인자

이준영,최귀연,강신욱,고강열 대한족부족관절학회 2018 대한족부족관절학회지 Vol.22 No.3

Purpose: The purpose of this study was to evaluate the radiologic outcomes of distal fibular fractures and to analyze the risk factors associated with nonunion. Materials and Methods: Between January 2009 and March 2016, 13 patients who had final nonunion with ankle fracture were included. In the control group, 370 patients who had undergone bony union and removed metal implants were included. All patients underwent the same surgical procedure and had the same treatment method, ultimately achieving satisfactory open reduction results with less than 2 mm fracture gap. Surgical treatment of fracture was considered to have the same effect on nonunion, and factors that might be associated with nonunion were evaluated. SPSS ver. 13.0 (SPSS Inc., USA) was used for all statistical analyses. Pearson’s chi-square test and multi-variate regression analysis were performed to determine the factors affecting nonunion of distal fibular fracture. A p-value less than 0.05 was considered statistically significant, and relative risk was assessed. Results: The mean age of 13 patients was 46.9 years (range, 16∼57 years); there were 8 men and 5 women. Among the 13 patients with nonunion, atrophic was the most common (12 cases). The association between the injury mechanism and the Lauge-Hansen classification and diabetes mellitus was not statistically significant. Distal fibular fractures with tibia shaft fracture (p=0.015) and Danis-Weber type C fracture (p=0.023), open fracture (p=0.011), and smoking (p=0.023) were significantly associated with nonunion. Conclusion: In this study, the combined injury of the ipsilateral tibia shaft fracture, open fracture, and Danis-Weber type C fracture may increase the possibility of nonunion. Therefore, caution is advised to prevent nonunion.

경거골유합술 후 발생하는 불유합과 관련된 인자에 대한 분석

이준영,김보선,이정우,Lee, Jun Young,Kim, Bo Sun,Lee, Jung Woo 대한족부족관절학회 2017 대한족부족관절학회지 Vol.21 No.3

Purpose: The aim of this study was to analyze the factors related to nonunion in tibiotalar arthrodesis. Materials and Methods: Eighty cases of ankle arthritis treated with tibiotalar arthrodesis in our hospital from November 2008 to November 2015 with more than one year follow up were analyzed. Simple anteroposterior and lateral radiographs after 6 and 12 months of surgery were analyzed. Union was defined as more than 50% connection of the trabecular bone at the ankle joint surface in the anteroposterior and lateral radiographs. The nonunion group was defined as no signs of union with persistent pain 9 months after surgery. The surgical approach, type of used screw, preoperative and postoperative ankle alignment, body mass index (BMI), bone mineral density, and patients' prior history were compared between the two groups. Results: There were 69 union cases and 11 nonunion cases. In the patient factors, the gender and BMI was related to nonunion (p<0.05). The mean preoperative and postoperative ankle alignment in the nonunion group was $9.93^{\circ}{\pm}6.92^{\circ}$ and $5.43^{\circ}{\pm}3.35^{\circ}$ respectively, and $9.80^{\circ}{\pm}7.55^{\circ}$ and $5.63^{\circ}{\pm}3.45^{\circ}$ in the union group, respectively; the difference was not statistically significant (p>0.05). In the technical factors, the transfibular approach showed a better relationship but the association was not significant (p<0.05). In 40 cases of the transfibular approach, 12 cases used cancellous screws, and 4 cases showed nonunion due to screw breakage. Conclusion: Technical factors, such as the surgical approach and the type of screw used can be a risk factor in nonunion. In addition, patients' factors, such as gender and BMI, must be considered to reduce the nonunion rate.

교합-압박 골수정으로 치료한 대태골 간부 골절의 불유합

박윤수,문영완,성기선 대한골절학회 2003 대한골절학회지 Vol.16 No.2

목 적: 내고정술 후 발생한 대퇴골 간부 불유합에서 골절 부에 압박을 가할 수 있는 교합-압박 골수정(IC Nail??, Osteo, Switzerland)을 사용한 동적 압박 골 유합술의 임상적 결과를 보고하고자 하였다. 대상 및 방법: 20명, 21례의 대퇴골 간부 불유합율 교합-압박 골수정 고정술로 치료하였다. 평균 나이는 44 (18~69)세였으며, 골절 후 기준 수술까지 8에서 45 (중앙값 19)개월이 경과하였고, 추시 기간은 6에서 49 (평균 29)개월이었다. 천지료로 폐쇄적 골수정 삽입술이 10례, 개방적 골수정 삽입술이 10례, 금속판 삽입술이 1례였고 17례에서 골이식 및 동역화 (dynamization) 등 한 번 이상의 부가적 시술이 시행되었고, 과혈관성 불유합이 17례, 부혈관성이 3례였으며, 감염성은 1례였다. 시술은 골수강 확공 후 골수정 고정을 하였고, 근위부에 동적 교합 나사못을 삽입한 후 압박 나사를 이용하여 골절 부위를 압박하였고, 골이식은 하지 않았다. 결 과: 1례를 제외한 20례에서 임상적, 방사선학적 유합이 이루어졌다. 방사선학적 유합은 기준 수술 후 4에서 15 (평균 7.4)개월에 이루어졌다. 개방적 골수정 삽입술 후 1회의 골수정 치환술과 2회의 골이식을 받은 36세 남자에서 술 후 12개월까지 유합을 얻지 못했다. 결 론: 확공 후 교합-압박 골수정 삽입술은 초기 치료 방법에 상관 없이 대퇴 간부 불유합의 치료에 효과적인 방법이라 생각된다. 그런, 이전의 골수정 치환술이 실패한 무혈관성 불유합에서는 부가적인 시술이 고려되어야 할 것으로 사료된다. Purpose: To evaluate the effectiveness of a specially designed Interlocking-Compression Nail(IC Nail??, Osteo, Switzerland) which allows compression force across the nonunion site for the treatment of femoral shaft nonunions. Materials and Methods: Between Nov. 1998 and June 2002, twenty one nonunions of femoral shaft fractures in twenty patients were treated with reamed IC nails of larger diameters without bone grafting in 9 men and 11 women, 8 to 45 months after initial operations. Seventeen cases were hypervascular nonunions, 3 avascular, and 1 infected. For initial operation, 10 closed nailing, 10 open nailing and 1 plate fixation were performed. One or more additional procedures had been done in 17 cases prior to IC nailing. Results: The nonunion gap was considerably narrowed from 7.4㎜ to 3.1㎜ with IC nailing and bony unions were achieved in all but one case. The time for radiographic union was 4 to 15 months posteoperatively with an average of 7.4. Conclusion: Reamed IC Nail?? with a larger diameter is an effective procedure for femoral shaft fracture nonunion regardless of initial treatment modalities and even in 3 avascular nonunions, 2 have shown radiographic union without bone grafting. Additional procedures are to be considered in failed surgery of avascular nonunions.

교합성 골수강내 금속정 치료 후 발생한 대퇴골 간부 골절의 불유합의 원인 및 치료

김성수 ( Sung Soo Kim ),손성근 ( Sung Keun Sohn ),김철홍 ( Chul Hong Kim ),이명진 ( Myung Jin Lee ),왕립 ( Lih Wang ) 대한골절학회 2007 대한골절학회지 Vol.20 No.2

목 적: 대퇴골 간부 골절에 시행한 교합성 골수강내 금속정 고정술 후 발생한 불유합에 대한 원인을 임상적으로 분석하고, 그 치료 결과를 문헌 고찰과 함께 보고하고자 한다. 대상 및 방법: 1999년 3월부터 2004년 2월까지 본원에서 대퇴골 간부 골절의 치료로 교합성 골수강내 금속정 고정술을 시행한 174예 중에서 비감염성 불유합으로 진단되고 수술적 치료 후 1년 이상 추시 가능하였던 19예를 대상으로 하였다. 본 연구에서는 술 후 대퇴골 불유합의 원인 요소들에 대해 분석하였고 불유합의 치료에 대해서는 금속정 교체술 그리고 금속정 교체 및 자가 골 이식술 두 가지 방법을 선택하였고 최종적으로 통계적 분석을 통해 최종적으로 두 가지 치료 방법에 따른 평균 골 유합 시기를 분석하고, 평균 골 유합 시기를 다른 불유합의 원인 요소들과 비교 분석하였다. 결 과: 수술 당시 평균 연령은 40세 (16∼78)였으며, 남자가 17예, 여자가 2예였다. 수술 방법은 불유합의 원인과 형태에 따라 결정하였고, 내고정 금속정 교체술만 시행할 경우가 10예, 금속정 교체술 및 자가 골 이식을 시행한 경우가 9예였다. 전 예에서 한 번의 수술로 골 유합을 얻을 수가 있었다. 전체적인 골 유합 기간은 금속정 교체술만 시행한 경우 평균 18.5주, 금속정 교체술 및 자가 골 이식을 시행한 경우 평균 16.1 주로 자가 골 이식술을 병행한 군에서 평균 골 유합 기간이 앞당겨졌고 통계학적으로 의미가 있었다(p<0.05). 평균 골 유합 시기에 따른 불유합의 원인 요소들과 비교한 결과 초기 개방성 골절 및 흡연군에서 유의한 유합 지연을 보였다 (p<0.05). 결 론: 대퇴골 간부 골절에서 골수강내 금속정 고정술 후 발생한 불유합의 양상, 골간격을기준으로 한 안정성에 따라 금속정 교체술 및 자가 골 이식술을 선택하여 전 예에서 골 유합을 얻을 수 있었으며 불유합을 골수강내 금속정 교체술로 치료 시 그 양상과 특히 골간격을 기준으로 골이식 추가 여부를 결정하는 것이 좋은 결과를 얻을 수 있다고 사료된다. Purpose: To analyze the causes and the clinical results of treatment for the nonunion of femur shaft fractures that occurred after interlocking intramedullary nail fixation. Materials and Methods: We reviewed 19 cases of aseptic nonunion of femur shaft fracture in 174 patients after interlocking IM nailing from March 1999 to February 2004 and followed up for more than one year. First we investigated the factors causing nonunion. For operative options, two methods about exchange nailing and exchange nailing with bone graft were performed. Finally clinical results were analyzed with bone union rate by treatment methods and com pared with the nonunion factors statistically. Results: According to the causes and types of nonunion, we performed larger IM nail change in 10 cases and IM nail change with bone graft in 9 cases. Bone union was achieved in all cases. Average bone union period were 18.5 weeks in exchange group and 16.1 weeks in exchange with bone graft group. There are significant difference between treatment methods statistically (p<0.05). Com pared with the nonunion factors, initial open fracture and smoking groups showed late union rate statistically. Conclusion: Based on our analysis, IM nail change is a useful method for nonunion after initial IM nailing in fem oral shaft fracture, and additional bone graft that according to the radiologic pattern and stability, especially the fracture gap is also a useful option for nonunion treatment.

고령 환자의 대퇴골 원위부 골절 수술 후 결과 및 불유합 위험 인자 분석

정수영,이재호,박기철 대한골절학회 2019 대한골절학회지 Vol.32 No.4

Purpose: Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion. Materials and Methods: This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients’ underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion. Results: The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045). Conclusion: The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors. 목적: 유수의 해외 학술지에서는 고령의 대퇴골 원위부 골절의 결과를 보고해 왔으나 현 시점에서 한국인을 대상으로 한대퇴골 원위부 골절의 결과를 분석한 논문은 극히 드물었다. 따라서 본 연구의 목적은 60세 이상 고령의 원위 대퇴골 원위부 골절 환자에서 최소 침습적 금속판 고정술 시행 후 결과및 예후의 영향 인자를 조사하고 불유합과 관계된 위험 인자를 분석하는 데 있다. 대상 및 방법: 본 연구는 후향적 연구로서 2008년 1월부터2018년 6월까지 대퇴골 원위부 골절로 최소 침습적 금속판고정술을 시행 받은 환자군을 대상으로 하였다. 제외 기준에 해당하는 121명을 제외한 후 총 52명의 환자가 연구에 등록되었다. 수술기록지를 포함한 의무기록을 검토하여 환자의기저 질환, 골밀도, 수술 지연 일수, 합병증 병발 여부 및 사망여부를 조사하였으며 추시 방사선 검사를 통해 골유합, 지연유합, 불유합을 판단하였다. 결과: 골유합을 획득하기까지 평균 기간은 19.95주였으며 불유합의 비율은 20.0% (10/50), 사망률은 3.8% (2/52)였다.인공관절 주위 골절 여부에 따른 임상 결과 및 방사선 결과에는 유의한 차이가 없었다. 단인자 분석에서 불유합의 위험 인자로 유의한 결과값은 없었으나 다인자 분석에서 암의 유무가 불유합의 위험 인자로 유의하다고 확인되었다(p=0.045). 결론: 한국인의 고령의 대퇴골 원위부 골절 환자에서 불유합의 비율은 여전히 높지만 사망률은 낮은 것으로 보인다. 암이불유합의 영향 인자가 될 수 있으며 추후 이외 인자들에 대한전향적인 연구들이 필요할 것으로 생각된다.