Treatment of Distal Femur Fractures with a Combined Nail-Plate Construct: Techniques and Outcomes

A combination treatment using a retrograde intramedullary (IM) nail and a lateral locking plate has scarcely been described in distal femur fracture treatment. In this retrospective inquiry, we review 97 patients who were treated for distal femur fracture by one of five fellowship-trained orthopedic trauma surgeons at an urban level-1 trauma center. Of the 97 patients enrolled in this investigation, eight were treated with a combined nail-plate hybrid construct. The remaining 89 patients were treated with either traditional IM nailing (22 patients) or locking plate fixation (67 patients) alone. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and postoperative outcome measurements were recorded for each patient in the study. All eight patients who were treated with the combined nail-plate construct proceeded to fracture union (100% vs. 69% in the control group; p = 0.33). Both procedure duration (p = 0.006) and total fluoroscopy time (p = 0.004) were significantly higher in the nail-plate construct group. No statistically significant difference was found between the two groups regarding complication rate. A combined nail-plate construct is a successful treatment alternative for acute management of distal femur fractures. This technique may be most beneficial for patients at higher risk for nonunion (i.e., those with open, comminuted metaphysis fractures) or those with a need for an additional load-sharing construct (i.e, osteopenic or noncompliant patients).