Does dual-plating offer superior stability in complex distal femoral fracture management?

Distal femoral fractures (DFF) present significant challenges in orthopedic surgery because of their complex biomechanical environment and limited bone stock for fixation. Dual plating (DP), involving the application of both lateral and medial plates, has emerged as a promising alternative to enhance construct stability. We hypothesize that distal femoral DP improves union rates and functional outcomes in patients with complex or non-united DFFs.

This prospective observational study was conducted on 30 cases with DFF who had either complex primary fixation or developed nonunion. Patients were monitored and followed up at regular intervals postoperatively (2 weeks, 6 weeks, 3 months, 6 months, and 12 months). Functional recovery was assessed using the Neer scoring system.

The range of motion (ROM) ranged from 70 to 100° with a mean ± SD of 90.17 ± 10.3°. The majority of patients (66.67%) achieved an excellent outcome, and 20% had a good result. Only a small proportion had fair (6.67%) or poor (6.67%) outcomes. There were no cases of malunion or nonunion. However, delayed union and infection were each reported in 3 patients (10%). Patients with excellent outcomes were significantly younger (mean age 24.9 years) and had a lower BMI (24.31 kg/m²) compared to those with poorer outcomes, who were older (≥ 55 years) and had higher BMIs (≥ 28.7 kg/m²).

Distal femur dual plating is a viable salvage option for complex primary fixation of complex distal femur fractures. Good to excellent outcomes can be achieved with a low complication rate especially in patients with normal BMI and younger than 55 years of age.