Dual Implant Constructs in Geriatric Distal Femur Fractures

Distal femur fractures in the elderly continue to rise in incidence and there is significant morbidity and mortality associated with these injuries. Geriatric distal femur fractures pose unique problems due to poor bone quality that often can lead to failed fixation and negative outcomes. Nonoperative management has been shown to be inferior to surgical treatment. Multiple treatment options exist including external fixation, open, and minimally invasive locked plate fixation, intramedullary nailing, nail-plate combination constructs, and arthroplasty. Dual implant constructs provide rigid fixation and have been shown to prevent varus collapse and nonunion. The addition of a medial plate has been shown to be biomechanically superior in distal femoral fractures, especially in those in which significant distal fixation is difficult. Indications for dual plate or nail-plate constructs include geriatric femur fractures with osteoporotic bone, low periprosthetic fractures around the knee, and distal femur fractures with extensive metaphyseal loss. Different approaches can be used to accomplish dual plating including both single and double incision techniques. Outcome studies on patients undergoing dual plate fixation demonstrate successful results with similar rates of failure and complication to other operative fixation strategies.