Distal femur fractures are most common traumatic injuries in young people and osteopenic females accounting for 3.6% of femur fractures and less than 1% of all fractures. The fracture is characterized in the region extending from the distal metaphyseal-diaphyseal junction to the articular surface of the femoral condyles.
Common treatment practices are lateral locking plate or intramedullary nail fixation, with disadvantages including risk of non and malunion and limited post-operative weightbearing status. According to a new study in Orthopaedic Surgery suggests combining both techniques as a nail-plate construct (NPC) achieves enhanced fixation to allow immediate weightbearing. The NPC provided stable fixation permitting full weightbearing post-operatively with no cases of non or malunion.
Investigators conducted a single-center retrospective study including all patients >18 years who sustained distal femur fractures treated with NPC. Primary outcomes were radiographic union, malunion and patient reported outcome measures at minimum 1-year follow-up. Secondary outcome measures included post-operative mobility, length of stay and complications. Relevant variables of normality are reported as mean with standard deviation. Subgroup analysis of patients aged <65 and ≥65 years are provided.
The key findings of the study are
• Sixteen patients were included in the study. Rate of radiographic union was 100%. There was no case of malunion.
• All patients were allowed to bear full weight immediately post-operatively. Mean length of stay was 9.50 days, with 37.5% of patients discharged directly home.
• The majority (85.7%) of patients returned to pre-injury mobility. Early post-operative complications occurred in three patients.
• Three patients returned to theater. The mean EQ-5D-5L index value was 0.713, with 71.4% describing no problems with self-care and 85.7% reporting no or slight problems with usual daily activities.
Researchers concluded that “The NPC provided stable fixation permitting full weightbearing post-operatively with no cases of non or malunion. Return to pre-injury mobility and activity are encouraging. Based on these results we support the use of nail-plate construct fixation in the management of distal femur fractures.”
Reference: Pfister, Benjamin, et al. "Best of Both Worlds? Fixation of Distal Femur Fractures With the Nail-Plate Construct." Orthopaedic Surgery, 2023. DOI: https://doi.org/10.1111/os.13927.