Distal femur plate-nail constructs. Belt and suspenders?

Given the inherent complexity of distal femoral fractures and non-unions, management should be directed by an experienced orthopaedic trauma surgeon to ensure optimal reduction and stable fixation. This report describes the surgical technique of three cases managed with dual nail-plate fixation, supplemented by a review of contemporary literature regarding this hybrid construct. Evidence from meta-analyses suggests that combined fixation significantly minimizes total complications and reoperations compared to single-construct fixation in distal femur fractures. Notably, these clinical benefits are achieved without a significant increase in operative duration, blood loss, or hospital stay. However, the current literature is restricted to retrospective studies, underscoring the imperative for prospective randomized controlled trials to validate these clinical benefits.