Nail plate construct in complex distal femur fractures allow safe, early unrestricted weight bearing with high rates of union and a low rate of failure: five-year experience at a UK major trauma centre.

PURPOSE: Distal femur fractures are challenging to manage and fixation with intramedullary nails or plates alone can fail. Linked nail plate constructs (NPC) are increasingly used for complex cases. This five-year review from a UK major trauma centre reports indications and patient outcomes.

METHODS

Patients treated for a distal femoral fracture with a NPC between 1st January 2020 and 1st January 2025 were identified. Patient demographics, mechanism of injury, fracture classification, procedural characteristics, postoperative weight-bearing status, union rates, complications and mortality were recorded.

RESULTS

Thirty-two patients were identified with a mean age of 70 years (20 to 98). Twenty-four (75%) patients were female with a median ASA of 3. There were five (16%) open fractures and ten (31%) peri-prosthetic fractures. Eight (25%) NPCs were revision operations following failure of primary fixation. All operations were performed by at least one consultant. In total, 31 (97%) patients were permitted unrestricted weight bearing postoperatively. Clinical union was achieved in 25 (96%) of 26 patients available for follow-up. There were no significant complications. Mortality rate at 30 days, 3 months and 12 months was 6%, 6% and 16%, respectively.

CONCLUSIONS

This study supports the use of nail plate construct (NPC) in the management of both primary and revision surgery for complex distal femoral fractures. Among 32 patients with a mean age of 70 years, NPC permitted immediate unrestricted weight bearing (97%) with a high rate of union (96%) and a low complication and mortality rates. These findings highlight NPC as an effective option for managing complex distal femur fractures.