Integrated nail plate construct for the management of complex distal femoral fractures in older patients

The management of distal femoral fractures (DFF) in older patients is challenging due to complex fracture patterns and osteoporosis. No consensus has yet been established on the optimal internal fixation strategy for DFF. Therefore, our research aimed to evaluate the clinical efficacy of the integrated nail plate construct (INPC) in treating complex DFF in older patients. We retrospectively analyzed 46 INPC-treated patients aged over 60 years with complex DFF at a Level I trauma center between October 2017 and June 2024. Baseline demographics and clinical data were documented. Operative parameters were systematically recorded, such as blood loss, operative time, postoperative complications, fracture healing times, and functional outcomes at the final follow-up (e.g., visual analog scale scores, Hospital for Special Surgery knee scores, knee flexion range of motion, and ambulation status). The cohort included 46 patients (17 males and 29 females), comprising 35 cases of native DFF and 11 cases of periprosthetic supracondylar femoral fractures classified as Rorabeck-Taylor Type II. The mean age was 73.2 ± 7.1 years, and 69.5% of patients had a body mass index greater than 25. The follow-up duration ranged from 18 to 24 months (20.9 ± 2.6 months); no nonunions or hardware failures occurred. Fracture healing time ranged from 16 to 40 weeks (21.6 ± 5.6 weeks). At final follow-up, all patients were capable of full weight-bearing either without pain or with mild pain, although eight patients required the use of a cane or walker. The postoperative complications included delayed fracture union (two cases), superficial wound infection (one case), and knee joint stiffness requiring surgical release following ineffective conservative management (one case). The preliminary observational findings suggest that INPC is a feasible fixation strategy for complex DFF in older patients, with satisfactory short-term outcomes.