Dual Construct for Very Low Periprosthetic Distal Femur Fracture-Case Series and Extensile Medial Parapatellar Single...

Area of Science:

• Orthopedic Surgery
• Traumatology
• Geriatric Medicine

Background:

• Periprosthetic fractures, particularly very low distal femur periprosthetic fractures (PPDFF), are increasing due to arthroplasty prevalence and an aging population.
• Osteopenia and complex fracture patterns in PPDFF can compromise fixation stability, especially with single-plate constructs.
• Dual construct fixation is a newer strategy offering enhanced stability and enabling immediate weight-bearing in frail geriatric patients.

Purpose of the Study:

• To evaluate fracture alignment changes one year after immediate weight-bearing post-surgery for very low PPDFF.
• To report fracture union and functional outcomes using a dual construct fixation technique.

Main Methods:

• Review of Type III Su Classification very low PPDFFs treated between 2020-2023.
• Surgical approach: extensile medial parapatellar single-incision.
• Fixation methods: dual plating (DPC) or nail-plate construct (NPC). Immediate weight-bearing allowed from Day 1.
• Outcome assessment: radiographs for malunion/non-union, WOMAC scores, knee range of motion, and complications.

Main Results:

• Eight patients (6 DPC, 2 NPC) were included. All achieved union at 8.0 weeks and consolidation at 35 weeks.
• Minimal changes in distal femoral alignment (LDFA: 1.4°, PDFA: 1.2°).
• Mean knee flexion of 100°, mean WOMAC score of 32, and Parker Mobility Score of 8 were reported. No change in ambulatory status or postoperative complications observed.

Conclusions:

• Dual construct fixation (dual-plating or nail-plate) provides stable fixation for very low PPDFF.
• This technique facilitates early union and safe, immediate postoperative weight-bearing in elderly patients.
• Dual construct fixation demonstrates favorable functional outcomes and maintains fracture alignment.