Fixation Modalities for Medial Void in Distal Femur Fractures: A Narrative Review
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: 10/04/2026Authors: 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.comAbstract
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 screwReferences
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