Comparison of nail-plate and double-plate fixation in primary and periprosthetic distal femur fractures in older adults.

INTRODUCTION

Distal femur fractures in the geriatric age group have a one-year mortality rate similar to hip fractures. Like hip fractures, treatment should focus on early mobilization to reduce morbidity and mortality. Nail-Plate Combination (NPC) and Double-Plate Combination (DPC) are suggested to allow early mobilization with low mechanical complication rates. This study aimed to compare the clinical and radiological outcomes of NPC and DPC in elderly patients with distal femur fractures.

METHODS

After the inclusion and exclusion criteria, 28 patients treated with NPC and 24 patients treated with DPC were included in the study. The clinical records and radiological images of these patients were evaluated using a standardized form. Operative time, intraoperative blood loss, range of motion (ROM), and Lysholm scores were obtained from the medical records of the patients. From the radiological records, findings of radiological union and measurements of the Anterior Lateral Distal Femur Angle (aLDFA) and the Anterior Posterior Distal Femur Angle (aPDFA) were obtained.

RESULTS

In the NPC group, the operative time was 120 (±22.5) minutes, and in the DPC group, it was 155±±23.75) minutes (p<0.001). In the NPC group, the amount of blood loss was 422.5 (±115) mL, while in the DPC group, it was 640 (±237.5) mL (p<0.001). At the 3rd month, the ROM was 100 (±17.5) degrees in the NPC group and 80 (±10) degrees in the DPC group (p<0.001). The Lysholm score at the 3rd month was 70 (±12.5) in the NPC group and 68.5 (±10) in the DPC group (p<0.001). The radiological union time was 12 (±2) weeks in the NPC group and 12 (±3.5) weeks in the DPC group (p=0.290). There was no significant difference between the two groups in terms of aLDFA measurements (81 [±4.75] vs. 81 [±1.75], p=0.356), while the aPDFA was 85.5 (±4) in the NPC group and 83 (±2) in the DPC group (p<0.001).

DISCUSSION: Immediate weight-bearing after surgery is crucial in elderly patients. Dual-implant systems aim to enable early mobilization, but full weight-bearing is often delayed with DPC. NPC patients could bear full weight earlier, likely contributing to better early ROM and clinical outcomes.

CONCLUSION

NPC showed several advantages over DPC, including less blood loss, shorter operative time, immediate full weight-bearing, better early ROM, and improved clinical scores. Complication and union rates were similar, but the benefits of NPC may be clinically meaningful.