Management of Distal Femur Fractures With Modern Plates and Nails

Abstract

Fractures of the distal femur, even those with articular extension, are well suited to surgical fixation with modern precontoured anatomic plates and nails. Numerous adjuvant techniques are available to the treating surgeon to obtain and maintain reduction while preserving fracture biology. Yet despite their proven track record and benefits over older implants, technical errors are common and must be overcome with proper preoperative planning and intraoperative attention to detail. This review summarizes the current state of the art regarding distal femur fractures, with an emphasis on relevant modern plate and nail surgical techniques, tempered by our current understanding of implant biomechanics, fracture healing, and long-term outcomes.

Comparison of Less Invasive Stabilization System Plate and Retrograde Intramedullary Nail in the Fixation of Femoral Supracondylar Fractures in the Elderly: A Biomechanical Study

“…The results for axial failure load in this study further indicated that intramedullary fixation was significantly superior to extramedullary fixation. This might be due to the fixation with IMN, which was closer to the force line of the lower limb, providing strong fixation; static fixation was also beneficial to fracture healing. At the same time, according to the ultimate load result, it could assist orthopaedic surgeons in the choice of weight‐bearing timing and mode after operation.…”

Intramedullary Nailing of Periarticular Fractures

“…This can be achieved with reduction clamps placed percutaneously through stab incisions prior to reaming and nail placement. 5 Bone hooks, cobb elevators, and co-linear reduction forceps can also be applied through limited incisions to effect reduction.…”

“…This position facilitates the use of strategically placed bumps or triangles in varying positions creating flexion or extension of the fracture to obtain reduction. 5 A large periarticular clamp placed across the femoral condyles can provide a direct "handle" on the distal fragment, and manual traction through this clamp can provide additional assistance with reduction. Applying the clamp more anterior or posterior provides a flexion or extension moment to the distal femur to counteract sagittal plane deformity.…”

“…Beltran described the technical pitfalls and pearls and reviewed results between modern plates and nails. 5 While no randomized controlled trial between modern nails and plates is yet published, the results of such a trial have been presented by Tornetta et al on a study of 126 patients. 11 They reported malalignment in 22% of IMN cases and 32% of plate cases.…”

Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial

“…Other relevant contributing factors include anterior notching of the femoral implant, rheumatoid arthritis, prolonged steroid therapy, female sex and neurological disease. [ 8 – 11 ]…”