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Sebastian Lotzien, Darius Jan Baron, Thomas Rosteius, Charlotte Cibura, Christopher Ull, Thomas Armin Schildhauer, Jan Geßmann

• \(\bf Background\) Distal femur nonunions are well-recognized contributors to persistent functional disability, with limited data regarding their treatment options. In the current study, we asked whether additional medial augmentation plating is a feasible treatment option for patients with aseptic distal femoral nonunion and intact lateral implants. \(\bf Methods\) We conducted a single-center, retrospective study including 20 patients treated for aseptic distal femoral nonunion between 2002 and 2017. The treatment procedure included a medial approach to the distal femur, debridement of the nonunion site, bone grafting and medial augmentation plating utilizing a large-fragment titanium plate. Outcome measures were bone-related and functional results, measured by the Hospital for Special Surgery Knee Rating Scale (HSS) and the German Short Musculoskeletal Function Assessment questionnaire (SMFA-D). \(\bf Results\) Eighteen of 20 nonunions showed osseous healing at 8.16 \(\pm\) 5.23 (range: 3–21) months after augmentation plating. Regarding functional results, the mean HSS score was 74.17 \(\pm\) 11.12 (range: 57–87). The mean SMFA-D functional index was 47.38 \(\pm\) 16.78 (range 25.74–71.32) at the last follow-up. Index procedure-associated complications included two cases of persistent nonunion and one case of infection. \(\bf Conclusions\) According to the assessed outcome measures, augmentation plating is a feasible treatment option, with a high proportion of patients achieving bony union and good functional outcomes and a few patients experiencing complications.