Treatment of displaced sagittal plane femoral condyle fractures (OTA 33 B1-2) with novel J-plate: technical trick and case series

Surgical treatment of unicondylar distal femur fractures remains a challenge. Achieving stable fixation to allow early range of motion and weightbearing is complicated by poor bone quality and articular surface comminution, commonly leading to poor outcomes. Multiple treatment strategies have been previously described including small fragment, large fragment, and anatomical plate fixation. However, given the variability of fracture patterns, anatomical implants often lack the appropriate geometry and fixation options required to provide adequate stabilization. With knowledge and application of the principles of fracture fixation, these injuries can be effectively treated with standard non-anatomically shaped, contourable implants. The objective of this report was to describe a technique that provides effective fixation in these cases and report on outcomes of a small series. This technique utilizes a dual-implant construct that includes a small or large fragment plate positioned to buttress the metaphyseal apex of the fracture, and a small fragment reconstruction plate contoured in the shape of a "J" (J-plate) that wraps around the femoral condyle and onto the anterior cortex of the femur. There are advantages to this technique compared to anatomically contoured plates, including precise placement of implants in biomechanically advantageous locations, orthogonal fixation, and decreased implant costs.