Nail Plate Combination Fixation Versus Lateral Locked Plating for Distal Femur Fractures: A Multicenter Experience

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Biomedical Engineering

Background:

• Distal femur fractures are complex injuries requiring effective fixation.
• Nail-plate fixation (NPF) and lateral locking plates are common treatment options.
• Comparative outcome data for these fixation methods are crucial for clinical decision-making.

Purpose of the Study:

• To evaluate clinical, radiographic, and functional outcomes of nail-plate fixation (NPF) for distal femur fractures.
• To compare NPF outcomes against a propensity-matched cohort treated with single lateral locking plates.

Main Methods:

• Multicenter retrospective cohort study involving ten Level 1 trauma centers.
• Patients with OTA/AO 33A or 33C distal femur fractures were included.
• Interventions included NPF (n=33) and lateral locking plates alone (n=867).

Main Results:

• NPF group had no unplanned reoperations for union or varus collapse; 90% achieved good ambulation.
• Lateral locked plating group had significantly higher reoperation rates (23% vs 3%, P=0.023) and varus collapse (10% vs 0%, P=0.069).
• NPF demonstrated significantly lower nonunion rates compared to lateral locked plating alone.

Conclusions:

• NPF is an effective treatment for distal femur fractures, including high-energy, open, and comminuted types.
• NPF showed superior outcomes regarding reoperation for nonunion and varus collapse compared to lateral locked plating.
• Further research is needed to identify optimal patient selection for NPF in distal femur fractures.