Medial plating of distal femur: which pre-contoured angular stable plate fits best?

Distal femur fractures comprise approximately 4% of all femoral fractures, with lateral plating being a common fixation technique. In recent years, dual plating with an additional medial plate has shown added benefit for Arbeitsgemeinschaft für Osteosynthesefragen C-type fractures, comminuted, osteoporotic distal femur fractures and non-union or malunion complications postsingle lateral plating. However, to our knowledge, there is no commercially available distal femur medial plate for fracture fixation. The aim of our study was to determine which of our current commercially available pre-contoured plates fit the medial distal femur best in an Asian population.

We evaluated 13 different pre-contoured angular plates on standardized sawbone models. The plates were first applied onto the medial distal femur and subsequent anterior-posterior and lateral radiographs were taken postapplication. The appropriateness of the fit of each plate was objectively compared using a scoring system derived from pre-determined plate- and screw-related factors.

The proximal humerus internal locking system plate had the best anatomical fit with the highest 'best fit score,' followed by the variable angle proximal tibia plate.

While non-anatomical plates may be successfully utilized, in view of the anatomical variations of the femur, ultimately an anatomical plate for the medial distal medial femur should be developed for ease of fixation.