Table 9.

Results of the systematic review for double plating of non-union of the femur

Title	Authors	Journal	Year	Level of vidence	Number of cases	Treatment	Mean follow-up (months)	Fracture healing	Complications	Functional outcome at final follow-up
Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft	Chapman et al.	The Journal of Bone and Joint Surgery	1999	IV	n = 18 Mean age: 47 years Range of age: 25–81 years	13 double plates, 4 single plates, and 1 interfragmentary screw Autologous bone graft used in all cases Condylar buttress plate antero-medial 95-degree screw and side-plate lateral	26 [SD 6–120] 1 patient lost to follow-up	All 18 non-unions had healed Average time to healing: 8 months (SD 3–20 months)	n = 3 1 infection 1 loss of motion of the knee 1 malunion	Range of motion of the knee was 101°(10°–135°)
Reattachment of complex femoral greater trochanteric nonunions with dual locking plates	Laflamme et al.	The Journal of Arthroplasty	2012	IV	n = 15 Mean age: 68 years Range of age: 42–88 years	2 locking plates contoured on the anterolateral and posterolateral surface of the greater trochanter Anterolateral plate: locking screws in the proximal and distal fragment	53.1 [SD 26–88]	Trochanteric union was achieved in 13 out of 15 cases	n = 5 1 associated stem fatigue failure had revision hip arthroplasty 1 failed reattachment 3 hardware removal	Trochanteric union was achieved in 13 patients (87%) Average total hip score was 14.8 ± 2.2 (Merle d'Aubigné) and 77.6 (± 12.8) (Harris Hip score)
Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: A case series of 14 patients	Maimaitiyiming et al.	Injury	2015	IV	n = 14 Mean age: 26 years Range of age 22–32 years	Double-plate fixation combined with bone grafting LCP was placed in the lateral proximal part of the femur LCP which would make a 90° angle to the first plate was placed in the anterior site of the femur	14.8 [SD 10–25]	Union was achieved in all the patients in a mean of 5.5 months	n = 0	Excellent results in all cases according to the Paley and Catagni criteria
Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions	Holzman et al.	Clinical Orthopedics and Related Research	2016	IV	n = 23 Mean age: 58 years Range of age: 35–83 years	16 aseptic non-unions: single-stage procedure, stable lateral plate and medial LCP with autogenous bone graft 7 non-unions with lateral plate failure: 1. new lateral plate and at least 2 months later a medial LCP with autogenous bone graft	18 [SD 6–94] 2 patients lost to follow-up	Union was achieved in 20 out of 21 cases within 12 months	n = 6 1 persistent nonunion and lateral broken plate 4 removal of symptomatic hardware 1 breakdown of the posterior iliac crest harvest site	Union was achieved in 20 out of 21 cases within 12 months
Double locking plate fixation for femoral shaft nonunion	Peng et al	European Journal of Orthopaedic Surgery & Traumatology	2016	IV	n = 33 Mean age: 46.9 years Range of age: 25–81 years	Double-locking plate fixation and autogenous cancellous bone graft	24.8 (SD 6–60)	All 21 femoral non-unions healed Union time was 5.3 months (range 4–7)	n = 0	100% union rate, physical function and bodily pain components of the SF-36 were 96 (range 90–99) and 94.2 (range 92–99)
Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: A case series of patients	Sun et al.	Clinical Research Report	2019	IV	n = 21 femoral non-unions Mean age: 42 years Range of age: 23–68 years	Double plating was performed using a locking compression plate and a reconstructive plate, cancellous bone granules were loaded into any bony defects	14.5 (8–28)	All femoral non-unions healed Average union times 8.2 (range 4–14)	n = 13 9 muscle atrophy 4 joint ankyloses	100% union rate, all patients achieved an excellent or good result for bone healing and function
Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique	Mardani-Kivi et al.	MUSCULOSKELETAL SURGERY	2019	IV	n = 41 Mean age: 35 years Range of age: 18–71 years	Double-plate fixation and autogenous bridging bone grafting	37 (SD 18–63)	Full union was obtained in all patients Union time was 5 months (range 4–8)	n = 9 1 deep-vein thrombosis 1 pulmonary embolism 7 movement limitations	100% union rate, at the final follow-up, 3 patients had 10°–20° movement 1 patient had 10° movement limitations in hip flexion and extension 3 patients had 20°–30° and 10° movement limitations in knee flexion and extension, respectively
J-bone graft with double locking plate: a symphony of mechanics and biology for atrophic distal femoral non-union with bone defect	Lu et al.	Journal of Orthopaedic Surgery and Research	2020	IV	n = 18 Mean age: 47.7 years Range of age: 28–63 years	Atrophic distal femur non-union with bone defect were treated with a combination of J-shaped iliac crest bone graft combined with double plate	22.1 (SD 14–34)	All 18 patients achieved primary bone healing Healing time was 6.7 months (range 3–12)	n = 3 2 superficial infections 1 knee stiffness	100% union rate, the mean time to weight bearing walking was 5.5 months (range 3–12) The rate of “excellent” and “good” Lysholm Knee Scoring Scale scores improved from 0% before surgery to 94.44% at 3 months after surgery
Outcome of revision surgery for bisphosphonate related subtrochanteric fracture non-union following failed intramedullary nailing	Pydisetty et al.	Injury	2020	IV	n = 10 Mean age: 71.5 years Range of age: 57–89 years	Lateral dynamic compression screw (DCS) plate and an anterior locking compression plate (LCP)	n.a 1 patient lost to follow-up	All 10 subtrochanteric non-unions healed Union time was 16 months (range 7–32)	n = 11 1 superficial infection 1 sacral sore 2 postoperative seroma 4 blood transfusion 1 HDU admission 1 periprosthetic fracture 1 fatigue failure	100% union rate, the mean period until fully weight bearing for all patients was 8 months (range 4–17 months