Tag Archive for: distal femur fracture

Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review

/in

Review Article | Vol 12 | Issue 1 | January-June 2026 | page: 21-24 | Sachin Kale, Ashok Ghodke, Tejaswini Milind Patankar, Gaurav Kanade, Abhilash Srivastava, Sagar Deshpande

DOI: https://doi.org/10.13107/ti.2026.v12.i01.80 Submitted: 09/02/2026; Reviewed: 04/03/2026; Accepted: 21/03/2026; Published: 10/04/2026

Authors: Sachin Kale [1], Ashok Ghodke [2], Tejaswini Milind Patankar [2], Gaurav Kanade [1], Abhilash Srivastava [1], Sagar Deshpande [3]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India. [2] Department of Orthopaedics, M G M Medical College Kamote Navi Mumbai, Maharashtra, India [3] Department of Physiotherapy, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India. Address of Correspondence Dr. Sachin Kale Department of Orthopaedics, Dr. D.Y. Patil Medical College, Navi Mumbai, Maharashtra, India. E-mail: sachinkale@gmail.com

Abstract

Medial void in distal femur fractures—resulting from metaphyseal comminution, cortical bone loss, or segmental defects—predisposes constructs to varus collapse, non-union, and hardware failure if left unsupported. This narrative review synthesises current fixation strategies to address the medial defect, including: (1) lateral locked plating with augmentation (subchondral rafting, kickstand/medial column screws, bone graft and substitutes, and cement augmentation), (2) dual plating with a medial buttress, (3) nail–plate combination constructs, and (4) emerging concepts such as far cortical locking and linked constructs. Across biomechanical and clinical studies, strategies that restore a medial buttress or create a stable load-sharing environment reduce varus collapse, improve radiographic parameters, and may shorten time to union in comminuted, osteoporotic, or peri‑articular patterns. Technique selection should be individualised by patient factors (bone quality, soft tissue, comorbidities), fracture morphology (AO/OTA 33‑A3/C3, periprosthetic, non‑union), and intra‑operative reduction behaviour. We propose a pragmatic, reduction‑first algorithm prioritising medial column support, balanced construct flexibility, adequate working length, and biological preservation. Future work should include comparative trials of dual plating versus nail–plate constructs with standardised indications and patient‑reported outcomes. Keywords: Distal femur fracture, Medial void, Dual plating, Nail–plate construct, Cement augmentation, Far cortical locking, Kickstand screw

References

1. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA. Treatment of distal femur fractures using the Less Invasive Stabilization System (LISS): early clinical results. J Orthop Trauma. 2004;18(8):509–520. 2. Schütz M, Müller M, Krettek C, Hontzsch D, Regazzoni P, Ganz R, et al. Minimally invasive fracture stabilisation of distal femoral fractures with the LISS: technique and early results. Injury. 2001;32(Suppl 3):SC32–SC47. 3. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28(2):83–89. 4. Tripathy SK, Goyal T, Sen RK, et al. Dual‑Plating in distal femur fracture: a systematic review. Cureus. 2021;13(1):e12685. 5. Thorne TJ, Arrington ED. Dual plating of distal femoral fractures. JBJS Rev. 2024;12(6):e23.00247. 6. Kook I, et al. The impact of medial‑first dual plating for reduction of distal femur fractures. Sci Rep. 2025;15. 7. Leal JA, et al. Medial augmentation of distal femur fractures using the contralateral lateral distal femoral locking plate. OTA Int. 2024;7(3):e335. 8. Chen SR, Shaikh H, Turvey BR, et al. Supplemental medial column screw fixation of distal femur fractures treated with a laterally based locked plate: technical trick. J Orthop Trauma. 2023;37:e175–e180. 9. Henningsen J, et al. Increased stiffness with medial column screw in distal femur fracture models: a biomechanical study. Injury. 2025. 10. Dimitroulias A, et al. Linking a nail and a plate for distal femur fractures. SICOT‑J. 2024;10:8. 11. Liporace FA, Yoon RS. Distal femur: nail–plate combination and the linked construct. OTA Int. 2022;5(3):e200. 12. Saraglis G, et al. Linked nail/plate construct for complex distal femur fractures: effectiveness and union. SICOT‑J. 2024;10:20. 13. Baumann AN, et al. Nail‑plate combination constructs versus single traditional constructs for distal femur fractures: comparative outcomes. Injury. 2024. 14. Xu W, et al. Comparison of retrograde nail plus lateral plate versus dual plating in AO/OTA 33C distal femur fractures: a retrospective cohort. Sci Rep. 2025;15. 15. Bäumlein M, et al. Cement augmentation of angular stable plate fixation in distal femur: biomechanical effects of fenestrated condylar screws. BMC Musculoskelet Disord. 2020;21:282. 16. Wähnert D, et al. Implant augmentation in the treatment of distal femoral fractures: a biomechanical investigation. Injury. 2013;44(6):785–789. 17. DeBaun MR, et al. Calcium phosphate cement and locked plate augmentation of large distal femoral defects: comparative study. Knee. 2019;26(5):1040–1048. 18. Bottlang M, Doornink J, Fitzpatrick DC, et al. Far cortical locking enables flexible fixation with periarticular locking plates. Clin Orthop Relat Res. 2011;469:1757–1765. 19. Bottlang M, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: prospective observational study. J Orthop Trauma. 2014;28(12):e276–e283. 20. Stockton DJ. Distal Femur Fractures—OTA Core Curriculum; selected readings and references (includes Ricci et al.). 2021.
How to Cite this article: Kale S, Srivastava A, Deore S, Yadav A, Kushdeep, Datta S | The Three-Stitch Technique for Antegrade Humerus Nailing: A Minimally Invasive Approach to Improved Functional Outcomes and Reduced Complications in Humerus Shaft Fractures Narrative review | January-June 2026; 12(1): 15-20 | https://doi.org/10.13107/ti.2026.v12.i01.78

(Abstract Text HTML)   (Download PDF)

Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate Retrospective study

/in

Vol 5 | Issue 1 | Jan-April 2019 | page:3-6 – Raviraj Shinde, Tanvi Shinde, Ajit Shinde

Author: Raviraj Shinde[1], Tanvi Shinde[1], Ajit Shinde[2]

1Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai.
2Shree AnnasahebShindeMhaishalkar Charitable Trust, Post Graduate Institute, Ambedkar road, civil hospital chowk, sangli

Address of Correspondence
Dr Raviraj Ajit shinde
Department of Orthopaedics, Grant Medical College and Sir.J.J. Group of Hospitals, Mumbai
Email Id : drravirajshinde@gmail.com

Abstract

Introduction: The overall incidence of distal femur fractures is approximately 37 per 100,000 person-years.1 These fractures are either caused by high energy trauma in younger group or low energy falls in elderly population typically older women. As these fractures can lead to long term disability managing them is challenging task. Operative treatment for fracture fixation is recommended for optimal outcome. Although different modes of fracture fixation has evolved and no single method is uniformly successful. In our study we have compared fixation of distal femur fracture using locking plate and intramedullary nail.
Materials and Methods: Retrospectively collected data of operated distal femur fracture of 60 patients was included. Out of these 30 patients were operated with retrograde distal femoral nail and 30 were operated with locking distal femur plate. Patients were assessed with plain radiographs and CT scan was done for complex and intra articular fractures.  AO ( Muller) classification was used to classify the fracture type. Postoperative functional results were evaluated using Schatzker and Lambert critera at 1 year follow up.
Results: Mean age of the patients in the study was 45 yrs. with 73.33 % male and 26.67 % female patients. There were 41 extra articular fractures (type A) while 19 were intrarticular fractures (type C). 22 type A and 8 type C fractures were treated with retrograde nailing while 19 type A fractures and 11 type C fractures were treated with locking plate. In LCP group 28.57% cases had excellent result while 42.86% cases had good result while in retrograde supracondylar nail 13.33% had excellent result and 23.33 % had good result. There were 2 cases of infection, one in each group and 3 cases of malunion, which were managed with nail. Delayed union was encountered in 3 patients, two of them were managed with LCP.
Conclusion: Open reduction and internal fixation of distal femur has achieved excellent to good functional results with locking plate construct in all types of fractures while retrograde supracondylar nail can achieve comparable results when used in simple extraarticular fractures.For other fractures it is difficult to maintain length, alignment and rotation with retrograde nail.
Keywords: distal femur fracture, Retrograde intramedullary nail, locking distal femur plate, minimally invasive plating technique, Schatzker and Lambert criteria

References

1. J Arneson, T & Melton, Joel & G Lewallen, D & M O’Fallon, W. (1988). Epidemiology of diaphyseal and distal femoral fractures in
Rochester, Minnesota, 1965-1984. Clinical orthopaedics and related research. 234. 188-94.
2. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults.ActaOrthop Scand. 1982 Dec;53(6):957-62.
3. Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures.IntOrthop. 2018 Jan; 42(1):191- 196. doi: 10.1007/s00264-017-3665-1. Epub 2017 Nov 7.
4. Cambell’s operative orthopedics,11th edition, Vol.3,pg-2805.
5. Schatzker J. Lambert DC: Supradondylar fracture of the femur; Clin. Orthop 138: 77, 1979.
6. Krishna C et al : Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate IntSurg J. 2016 Aug;3(3):1356-1359
7. El Moumni M, Schraven P, ten Duis HJ, Wendt K: Persistent knee complaints after retrograde unreamed nailing of femoral shaft fractures. ActaOrthopBelg 2010;76:219–225.
8. Ricci WM, Loftus T, Cox C, Borrelli J. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 2006 ; 20 : 190-196.
9. Krishna C et al : Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate IntSurg J. 2016 Aug;3(3):1356-1359
10. Gupta SKV, Govindappa CVS, Yalamanchili RK. Outcome of retrograde intramedullary nailing and locking compression plating of distal femoral fractures in adults. OA Orthopaedics 2013 Nov 01;1(3):23.
11. Hierholzer C, von Ruden C, Potzel T, Woltmann A, BuhrenV:Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fracture: a retrospective analysis. Indian J Orthop. 2011;45:243-50.

How to Cite this article:  Shinde R, Shinde T, Shinde A. Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate; Retrospective study. Trauma International Jan-Apr 2019;5(1):3-6

(Abstract)(Full Text HTML)   (Download PDF)