The Role of Adjunctive Medial Plating in Distal Femur Fractures and Distal Femur Fractures Nonunions

There exists controversy in the treatment of acute distal femur fractures as well as distal femur fracture nonunions. The objective of this study is to determine the clinical benefit of adjunctive medial plate application in the setting of acute distal femur fractures and distal femur fracture nonunions.

This is a retrospective comparative study at a Level 1 academic trauma center, including 104 patients treated for acute distal femur fractures and 23 patients treated for distal femur nonunions between 2015 and 2019. The study compared dual plate fixation to other methods of fixation.

In the acute fracture setting, the dual-plate construct had a shorter time to union (22.1 weeks vs. 29.5 weeks, p=0.1337) and a better union rate (100% vs. 73.6%, p=0.1848), though neither were statistically significant. Complication rates between dual plating and single lateral plating were similar (20% dual plate vs. 14.3% single lateral plate, p=0.7245). For femoral nonunions, both treatment groups achieved a 100% union rate. The time to union was slightly longer in patients treated with an adjunctive medial plate (35 weeks vs. 31 weeks, p=0.6207). However, medial adjunctive plating had a lower complication rate (0% vs. 26.7%, p=0.1081).  Conclusion: Dual plating plays a valuable role in the management of acute distal femur fractures, as well as in the adjunctive medial plating of distal femur nonunions treated with a lateral plate construct. This approach is especially beneficial for cases with inadequate medial cortical support or a high risk of varus collapse.