“Redefining success in failed distal femur fracture fixations: The augmented nail plate construct (NPC) approach”

This study aimed to evaluate the clinical and radiological effectiveness of the nail-plate construct (NPC) in treating previously failed distal femur fracture fixations. Additionally, the study assessed patient-reported outcomes and mobility at a minimum of 2 years post-surgery, and reported complication rates. A prospective study was conducted at Grant Medical College and Sir JJ Group of Hospitals, Mumbai, from January 2018 to December 2022. Seventeen patients with failed distal femur fracture fixations were included. The surgical technique combined locking plates (LP) and intramedullary nails (IMN). Post-operative protocols included early mobilization and customized rehabilitation plans. Outcome variables included bone fusion, malunion, post-operative mobility, weight-bearing status, length of hospital stay, complications, and Oxford Knee Scores. The mean age of patients was 65.05 ± 7.26 years, with a mean follow-up of 26.23 ± 2.46 months. The radiological assessment showed a 94.11 % union rate, with 11.76 % delayed union, 5.88 % non-union, and 5.88 % malunion. The average postoperative Oxford Knee Score was 36.64 ± 5.49, with most patients achieving favorable outcomes. The average knee range of motion post-surgery was 109° ± 17.48°. Complications included superficial wound infection in one patient and initial degenerative changes in another. The NPC technique demonstrated robust fixation and facilitated immediate postoperative mobilization without compromising union integrity. With a high union rate and favorable functional outcomes, NPC effectively mitigates the limitations of standalone nailing or plating. The findings support NPC as a viable option for managing complex distal femur fractures with prior fixation failures.