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To evaluate the outcomes of a nail-plate construct for treating distal femur fractures, particularly in the elderly population.

March 14, 2026Cureus0 citationsOpen Access

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Functional and Radiological Outcomes of Distal Femur Fractures Treated With a Combination of Supracondylar Nails and Lateral Condylar Locking Plates

NJNilesh JoshiNKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital DSDarshan H SharmaNKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital SDShantanu DeshkmukhNKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital

Key Points

To evaluate the outcomes of a nail-plate construct for treating distal femur fractures, particularly in the elderly population.
Prospective observational study
Included adult patients with acute distal femur fractures
Subgroup analysis based on age
Evaluated radiological union, postoperative mobilization, and patient-reported outcomes using EQ-5D-5L questionnaire
Radiological union achieved in all patients at one-year follow-up
No cases of malunion or implant failure
Postoperative mobilization was feasible across all age groups
Most patients reported favorable functional recovery with minimal problems
Postoperative complications found mainly in elderly patients with some requiring reoperation

Abstract

Introduction Distal femur fractures are associated with significant morbidity, particularly in elderly patients, and achieving stable fixation that permits early mobilization remains challenging. The nail-plate construct (NPC) combines the biomechanical advantages of intramedullary nailing and lateral locking plate fixation and may provide improved stability and functional outcomes. Methods This prospective observational study evaluated adult patients with acute distal femur fractures treated using an NPC at a tertiary care center. Thirty-two patients were included and subgrouped based on age (<65 years and ≥65 years). Radiological union and malunion at one-year follow-up were the primary outcomes. Secondary outcomes included postoperative mobilization, length of hospital stay, complications, and patient-reported outcomes measured using the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire. Results The median age of the cohort was 70.5 years (range: 30-91), with the majority aged ≥65 years. Low-energy mechanisms accounted for 28 (87.5%) of fractures, and 30 (93.8%) were closed injuries. At one-year follow-up, radiographic union was achieved in all patients, with no cases of malunion or implant failure. Early postoperative mobilisation was feasible across age groups. The mean EQ-5D-5L index value demonstrated favourable functional recovery, with most patients reporting no or only slight problems with mobility, self-care, and usual activities. Postoperative complications occurred predominantly in the elderly subgroup, with a small proportion requiring reoperation. Conclusion NPC fixation for acute distal femur fractures resulted in excellent radiological union, early mobilization, and favorable patient-reported outcomes at one year. This technique appears to provide stable fixation that supports early rehabilitation, particularly in elderly patients. Larger comparative studies with longer follow-up are required to further define its role relative to isolated fixation methods.

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Functional and Radiological Outcomes of Distal Femur Fractures Treated With a Combination of Supracondylar Nails and Lateral Condylar Locking Plates

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