Best of Both Worlds? Fixation of Distal Femur Fractures with the Nail-Plate Construct. Patient-Reported Outcomes and One-Year Results in a Heterogenous Population

Objectives: Distal femoral fractures are a significant injury sustained by low- and high-energy trauma. Common treatment practices are lateral locking plate or intramedullary nail fixation, with disadvantages including risk of non- and mal-union and limited post-operative weightbearing status. Combining both techniques as a nail-plate construct (NPC) theoretically achieves enhanced fixation to allow immediate weightbearing. This study examines the functional, radiographic, and patient-reported outcomes of distal femur NPC fixation. Methods Single-centre combined prospective and retrospective study including all patients > 18 years who sustained distal femur fractures treated with NPC. The primary outcome was radiographic union and malunion at minimum one-year follow-up. Secondary outcome measures included patient reported outcome measures, post-operative mobility, length of stay and complications. Results Sixteen patients were included in the study. Rate of radiographic union was 100%. There was no case of malunion. All patients were allowed to full weight bear immediately post-operatively. Mean length of stay was 9.50 days, with 37.5% of patients discharged directly home. The majority (85.7%) of patients returned to pre-injury mobility. Early post-operative complications occurred in three patients. Three patients returned to theatre. The mean EQ-5D-5L index value was 0.713, with 71.4% describing no problems with self-care and 85.7% reporting no or slight problems with usual daily activities. Conclusions The NPC provided stable fixation permitting full weightbearing post-operatively with no cases of non- or malunion. Return to pre-injury mobility and activity are encouraging. Based on these results we support the use of nail-plate construct fixation in the management of distal femur fractures.