Best of Both Worlds? Fixation of Distal Femur Fractures with the Nail‐Plate Construct

OBJECTIVES: Distal femoral fractures are a significant injury sustained by low‐ and high‐energy trauma. 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. Combining both techniques as a nail‐plate construct (NPC) theoretically achieves enhanced fixation to allow immediate weightbearing. The aim of this study is to examine radiographic union, malunion and patient‐reported outcomes in distal femur NPC fixation. METHODS: 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. RESULTS: 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. CONCLUSION: 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.