Cost-conscious comparison of dynamic condylar screw versus locking compression plate fixation in distal femur fractures: a comprehensive functional and physiotherapy-oriented evaluation

Background: Distal femur fractures are complex injuries associated with substantial morbidity, particularly in comminuted and intra-articular patterns. Locking Compression Plates (LCP) provide angular stability and facilitate early mobilization, whereas Dynamic Condylar Screws (DCS) remain a cost-effective option in resource-limited settings. This study compared radiological, functional, rehabilitation and economic outcomes between LCP and DCS fixation under a standardized physiotherapy protocol. Methods: A retrospective-prospective observational cohort study was conducted from January 2018 to December 2021 involving 33 adults with AO/OTA 33-A or 33-C distal femur fractures. Eighteen patients underwent distal femur LCP fixation and 15 underwent DCS fixation. All patients followed a structured continuous passive motion (CPM)-assisted rehabilitation program. Outcomes assessed included radiological union, knee range of motion, functional scores, complications, and treatment cost. Results: The LCP group demonstrated earlier radiological union (approximately 16 to 17 weeks vs. 19 weeks in the DCS group) and superior knee flexion throughout rehabilitation. Final knee flexion ranged from 1050 to 1220 in the LCP cohort compared with 950 to 1120 in the DCS cohort. Functional outcomes, including Knee Society Score, Lysholm score, Neer’s grading, and Timed Up and Go performance, favoured LCP fixation. Varus malalignment and non-union were more frequent in the DCS group. However, LCP fixation incurred 35% to 45% higher direct treatment costs. Conclusions: LCP fixation provides earlier union, improved range of motion, and superior functional recovery compared with DCS fixation, particularly in comminuted and osteoporotic fractures. Despite higher costs, LCP with structured CPM-assisted rehabilitation may offer better outcomes in selected high-demand patients, while DCS remains a cost-effective option for simpler fracture patterns.