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

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.