Guide plate technology improves traditional fluoroscopy on the fixation of AO/OTA 33-C distal femur fractures with integrated nail–plate double distalis entry technique: a retrospective comparative study

Introduction NPC (nail–plate construct) has become the surgical mainstay for AO/OTA 33-C-type femoral fracture. Two NPC (nail–plate construct) techniques have been developed: a dedicated surgical guide device-assisted technique (NPC-GD) which adjusts conventional intraoperative fluoroscopy to lead to more accurate reduction of fractures and safer implant placement than ordinary fluoroscopy-guided technique, and a regular fluoroscopy-guided technique (NPC-GF). Aim: Comparison of surgical outcomes, quality of life and functional recovery in patients with AO/OTA 33-C-type femoral fractures using either NPC-GD or NPC-GF. Methods A retrospective comparative analysis was conducted among 161 cases enrolled from Jan. 2020 to Jan. 2025 including 86 cases in NPC-GD group and 75 cases in NPC-GF group. Operative time, operation blood loss, fluoroscopy frequency, rate of malunion, healing time, weight-bearing time, knee range of motion and HSS knee score were statistically compared. Outcome evaluations were all performed in a blinded fashion. Results This final analysis included 161 patients: 86 in the NPC-GD group and 75 in the NPC-GF group. NPC-GD group had a shorter operative time ( P = 0.006), intraoperative ( P = 0.004) and postoperative ( P = 0.003) blood loss, fewer numbers of intraoperative fluoroscopic images ( P = 0.034), shorter time to radiographic fracture union ( P = 0.037), earlier onset of walking at final follow-up ( P = 0.001), earlier achievement of full weight-bearing at final follow-up ( P = 0.009), greater final knee range of motion ( P = 0.009), better HSS knee scores ( P = 0.002). Conclusions NPC-GD is the optimized fluoroscopy technique; it reduces the surgical damage and excess irradiation. NPC-GD can facilitate fracture healing and achieve satisfactory repair of knee function, which is a preferred method of AO/OTA 33-C distal femoral fracture internal fixation.