Dual Plating Through a Single Anterior Approach for Distal Femoral Fractures

Comminuted distal femoral fractures and very low periprosthetic fractures present significant treatment challenges, which are commonly associated with nonunion and varus collapse. Dual plating has emerged as an effective solution to address these issues. The aim of this study was to evaluate the clinical outcomes of osteosynthesis with double plates through a single anterior incision.

Forty-nine patients (38 females, 11 males, mean age 65.7 ± 16.2 years, range 23-90 years) were included. The study comprised 18 acute distal femoral fractures (AO/OTA 33-C2/C3), 15 acute periprosthetic fractures (Su classification 2-3), and 16 distal femoral nonunions (13 with a history of acute distal femoral fractures and 3 with periprosthetic fractures). Demographic data, hospitalization time, follow-up duration, union time, and complications were assessed.

The mean hospitalization time was 5.5 ± 3 days, with a mean follow-up of 13.6 ± 10.3 months (range 6-42 months). All fractures healed with a mean union time of 4.8 ± 1.6 months. Union times were 4.2 ± 1.5 months for distal femoral fractures, 4.1 ± 1 months for periprosthetic fractures, and 5.8 ± 1.5 months for nonunion fractures. Complications included one implant failure after a fall, one intraoperative vascular injury, and two superficial infections.

Dual plating through a single anterior incision is a reliable technique for comminuted distal femoral fractures, very low periprosthetic fractures, and distal femoral nonunion. It provides stable fixation, promotes early healing, and minimizes soft tissue complications.