The impact of medial-first dual plating for reduction of distal femoral fractures: a retrospective comparative cohort study

In dual-plate fixation of distal femoral fractures (DFF), reducing the relatively spared medial side first and using this metaphyseal-medial condylar segment as a template to reduce the lateral side may effectively facilitate reduction. This study evaluated the effectiveness of the medial-first dual-plate fixation in DFF. A retrospective study was conducted on 77 patients who underwent open reduction and internal fixation (ORIF) for DFF at a single institution between April 2012 and 2021. The patients were divided into a group in which medial-side ORIF was first performed followed by a lateral-ORIF (group M) and a lateral-ORIF only performed (group L). The demographic data, fracture classification, clinical outcomes, including operative time, estimated blood loss, complications, patient satisfaction, and pain level, and radiographic outcomes of the two groups were compared. There was no difference in the demographics or fracture classification between group M (n = 27) and group L (n = 50). The operative time was similar in the two groups. Group M had a significantly smaller articular gap, better union rate, shorter time to union, and stronger maintenance of coronal and sagittal alignment (P < 0.05). There were no significant differences in estimated blood loss, complications, reoperation rate, patient satisfaction, or pain level between the two groups. Medial-first dual-plate fixation showed better radiographic and comparable clinical results compared to lateral single-plate fixation in treating DFF. Medial-first dual-plate fixation facilitates the reduction and is believed to increase the reduction quality.