Nail-plate combination versus single construct for the management of distal femoral fractures: a meta-analysis.

Background: The management of distal femoral fractures (DFFs) can be challenging, with a historically high rate of non-union and reoperations. While lateral locked plating and intramedullary nailing were shown to have similar rates of non-union, nail-plate combinations (NPC) have been shown to have higher rates of union and improved clinical outcomes compared to single constructs (SC). The purpose of this meta-analysis was to compare NPC and SC in the treatment of DFFs.

Methods: PubMed, Cochrane, and Google Scholar databases (pages 1-20) were queried through October 2024. Studies that compared NPC to SC in patients with DFF were included. Outcomes including overall complications, specific complications (implant failure, heterotopic ossification (HO), nonunion, malunion, and surgical site infection (SSI)), reoperations, immediate post-operative weight-bearing status, and surgery-related parameters (operative room (OR) time, estimated blood loss (EBL), and length of stay (LOS)) were compared between the two groups.

Results: Five retrospective studies including 637 patients met the inclusion criteria (146 patients in the NPC group and 491 patients in the SC group). The NPC group had a lower rate of overall complications (OR 0.21, p < 0.001), reoperations (OR 0.29, p < 0.001), implant failure (OR 0.15, p = 0.01), non-unions (OR 0.12, p < 0.001), and malunion (OR 0.29, p = 0.03). Furthermore, the NPC group had a lower rate of patients instructed to be non-weightbearing post-operatively (OR 0.06; p < 0.001). There was no difference in HO, SSI, OR time, EBL or LOS between the 2 groups.

Conclusion: The present meta-analysis demonstrates a reduced rate of complications, reoperations, implant failure, nonunions and malunions in patients undergoing NPC for DFFs.

Level of evidence: III.