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Background <p>Mechanical instability due to long metaphyseal comminution and medial bone gap after lateral locking plate results in varus collapse and implant failure. We believe that fixation in the form of Nail and plate combination provides better stability and prevents complications.</p> Materials <p>We performed a retrospective analysis of 56 distal femur fractures with long metaphyseal comminution treated in our institution with nail and plate construct from 2017 to 2023. The mean age was 43.1 years and the mean follow up was 24 Months (4–36 months). Of these 56 patients, 16 were closed injuries underwent primary fixation, and 40 were open injuries requiring staged reconstruction. At the final follow up, patients were assessed for shortening, knee range of movements, Sander et al. functional score, radiological union and loss in alignment.</p> Results <p>The mean length of metaphyseal comminution was 10.15&#xa0;cm(5–18&#xa0;cm). Primary Iliac crest bone grafting was done in 25 patients. Of the 56 patients, 51 achieved primary union and the mean time to union was 6 months. Of the remaining, 3 patients united after secondary bone grafting and 2 patients had nonunion. The mean loss in aLDFA at the final follow up was 1.75° in 7 patients. Shortening of the limb was noted in 16 patients, and 4 patients had significant shortening of 2&#xa0;cm. Three patients developed deep SSI, of which one patient required debridement and 2 patients required implant removal. Patients achieved an average of 0–85° flexion and 0–5° extension. Functionally, 8 patients had excellent, 25 had good, 15 had fair and 8 patients had poor score.</p> Conclusion <p>The technique of combined intramedullary nail and plate fixation provides adequate stability and achieves good outcome in distal femur fractures with segmental metaphyseal comminution. Nail restores the anatomical alignment, and the plate provides rotational stability to the short distal fragment.</p>

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Is nail plate fixation the way forward for distal femur fractures with long segmental metaphyseal comminution? – A study of 56 patients

  • 期刊论文

  • 发表日期：

    2026年6月18日

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  • Harish Mahesan,
  • Velmurugesan Purnaganapathi Sundaram,
  • Agraharam Devendra,
  • Perumal Ramesh,
  • Jayaramaraju Dheenadhayalan,
  • Shanmuganathan Rajasekaran

摘要

Background

Mechanical instability due to long metaphyseal comminution and medial bone gap after lateral locking plate results in varus collapse and implant failure. We believe that fixation in the form of Nail and plate combination provides better stability and prevents complications.

Materials

We performed a retrospective analysis of 56 distal femur fractures with long metaphyseal comminution treated in our institution with nail and plate construct from 2017 to 2023. The mean age was 43.1 years and the mean follow up was 24 Months (4–36 months). Of these 56 patients, 16 were closed injuries underwent primary fixation, and 40 were open injuries requiring staged reconstruction. At the final follow up, patients were assessed for shortening, knee range of movements, Sander et al. functional score, radiological union and loss in alignment.

Results

The mean length of metaphyseal comminution was 10.15 cm(5–18 cm). Primary Iliac crest bone grafting was done in 25 patients. Of the 56 patients, 51 achieved primary union and the mean time to union was 6 months. Of the remaining, 3 patients united after secondary bone grafting and 2 patients had nonunion. The mean loss in aLDFA at the final follow up was 1.75° in 7 patients. Shortening of the limb was noted in 16 patients, and 4 patients had significant shortening of 2 cm. Three patients developed deep SSI, of which one patient required debridement and 2 patients required implant removal. Patients achieved an average of 0–85° flexion and 0–5° extension. Functionally, 8 patients had excellent, 25 had good, 15 had fair and 8 patients had poor score.

Conclusion

The technique of combined intramedullary nail and plate fixation provides adequate stability and achieves good outcome in distal femur fractures with segmental metaphyseal comminution. Nail restores the anatomical alignment, and the plate provides rotational stability to the short distal fragment.