More is More — What You Get By Adding a Nail to a Plate in Distal Femoral Fractures

An infrequently used approach may deliver real benefits

What’s the Claim?

A well designed, 10-center, propensity-score matched study found that using a retrograde intramedullary nail in addition to a lateral locked plate for patients with metaphyseal or intra-articular (AO/OTA 33A or 33C) distal femoral fractures was superior to using a lateral locked plate alone. Specifically, patients treated with the nail-plate combo had:

  • Many fewer unplanned reoperations for reasons other than infection compared to the lateral locking plate (23% versus 3%), and
  • A lower risk of developing varus collapse compared to those treated with a lateral plate alone (10% versus 0%)

These were tough fractures — 64% were high-energy injuries, one-third were Gustilo-Anderson type III open fractures, nearly 60% were intra-articular, and over 60% had medial comminution. There were no statistical differences in infection risk between the approaches, and few infections overall.

How’s It Stack Up?