Nail Plate Constructs are Associated With Decreased Rates of Reoperation in Complex Distal Femur Fractures

Objectives:To determine whether nail plate constructs have lower rates of reoperation to promote bone healing than lateral locking plates in the treatment of distal femur fractures.Design:Retrospective cohort.Setting:Single Level 1 trauma center.Patients/Participants:Three hundred twelve consecutive patients treated operatively for native distal femur fractures (OTA/AO 33A or 33C).Intervention:Reduction and fixation of distal femur fractures with a lateral locked plate (LLP) or a nail + plate construct (NPC).Main Outcome Measurements:Reoperation to promote bone healing at any time after definitive fixation.Results:Two hundred seventy-nine fractures were treated with LLP and were compared with 33 fractures treated with NPC constructs. Patient demographics, injury severity score, and frequency utilization of each construct between different types of OTA/AO-classified distal femur fractures were similar. The reoperation rate to promote bone healing was 18.7% (51/273) for LLPs, and 3% (1/33) for NPC constructs. There was no significant difference in surgical site infection (P = 0.67).Conclusions:Utilization of NPC technique demonstrated a significant decrease in rates of reoperation to promote bone healing compared with LLP alone in the treatment of OTA/AO 33A and 33C distal femur fractures. Augmented fixation with NPCs should be considered to treat complex distal femur fractures, because it is associated with lower rates of reoperation to promote bone healing in comparison to LLP.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.