Nail-Plate Combination Fixation for Periprosthetic Distal Femoral Fractures Allows Early Weight-Bearing With Low...

Area of Science:

• Orthopaedic surgery
• Trauma surgery
• Biomedical engineering

Background:

• Periprosthetic distal femoral fractures (PDFFs) present complex treatment challenges.
• Traditional fixation methods include locked plating or intramedullary nailing (IMN).
• A combined nail-plate construct (NPC) may offer enhanced stability and facilitate early mobilization.

Purpose of the Study:

• To compare clinical and radiographic outcomes of PDFF treatment using nail-plate combination (NPC) versus locked plating or isolated intramedullary nail (IMN) fixation.
• To evaluate the efficacy and safety of different fixation strategies for PDFFs.

Main Methods:

• Retrospective study of 79 PDFFs in 78 patients (≥18 years) across three institutions (2015-2024).
• Patients were treated with NPC, locked plate only (single, dual, or triple plates), or isolated IMN.
• Fractures classified using Orthopaedic Trauma Association/Arbeitsgemeinschaft für Osteosynthesefragen 33A-C and Su and Associates' Classification.

Main Results:

• Postoperative immediate weight-bearing as tolerated was achieved in 79.2% of NPC patients versus 40.0% of other constructs (P < 0.001).
• No significant differences in 2-year survivorship free of unplanned reoperation were observed between fixation groups (NPC 91.0%, single implant constructs 85.0%, all dual/triple plates 76.0%, P > 0.05).

Conclusions:

• Nail-plate combination (NPC) fixation for PDFFs is associated with favorable outcomes, including low reoperation and revision rates.
• NPC constructs may enable earlier weight-bearing in PDFF patients without compromising fracture union.
• This approach offers a potential advantage in managing complex distal femur fractures.