The importance of medial support in complex distal femur fractures: an expert survey of AO trauma Italy members and evidence-based treatment recommendations

BACKGROUND: Distal femur fractures (DFFs) are quite common injuries, accounting for 1% of all fractures and 3-6% of femoral fractures. This type of fracture has grown increasingly alarming as the world’s population ages. The aim of this study was to examine and interpret the results of a survey that we submitted to Italian orthopedic surgeons to establish an algorithm for treating both these fractures and complications related and also to enhance the real importance of medial support in distal femur fractures.METHODS: A webinar survey developed from the current literature was emailed to 101 Italian orthopedic doctors who were members of the AO/OTA and AUOT associations. Several questions were asked to the surgeons regarding medial support in distal femur fractures, their experience with several types of treatment, stability principles, complications, and rehabilitation procedures.RESULTS: According to literature and to the results of this survey, double plate (lateral + medial) is considered the most stable technique, despite many Italian surgeons (71.29%) use only lateral LCP. In case of metaphyseal comminution, osteoporotic bone, non-unions and periprosthetic fractures medial support it is recommended by using medial plate in order to guarantee bone vascularization respecting “the safe zone.”CONCLUSIONS: Guidelines are required not only for surgical treatment, but also to avoid or treat the percentage of non-union related to this fracture pattern.