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. 2024 Nov 5;7(4):e350.
doi: 10.1097/OI9.0000000000000350. eCollection 2024 Dec.

Linking a nail and a plate for distal femur fractures: a technical trick

Apostolos Dimitroulias  1 , Ashley Force  2 , Sandip Tarpada  3 , Yelena Bogdan  1 , Milan K Sen  1
Affiliations

Linking a nail and a plate for distal femur fractures: a technical trick

Apostolos Dimitroulias et al. OTA Int. .

Abstract

The use of nail-plate constructs has been suggested for treatment of elderly patients with distal femur fractures to facilitate stable fixation and early ambulation. In this article, we describe a technique to link the 2 implants without the use of fluoroscopic "perfect-circle" technique. This technique can be used with implants from different manufacturers.

Keywords: distal femur fracture; distal femur plate; nail plate; retrograde nail.

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Conflict of interest statement

The authors have no conflict of interest related to the contents of this manuscript.

Figures

Figure 1.
Figure 1.
Fluoroscopic and clinical images of a patient with right distal femur fracture. The retrograde nail is inserted, the distal most locking screw is drilled from medial to lateral, and the drill bit is left prominent laterally.
Figure 2.
Figure 2.
Fluoroscopic and clinical images demonstrating the inserted plate with the most distal anterior plate hole passed through the protruding tip of the drill bit.
Figure 3.
Figure 3.
A, The plate is compressed against the distal femur with a large clamp. A (nonlinking) screw has been inserted to hold the position of the plate. B, The drill is pulled back from the medial side as the screw linking the plate to the nail is inserted from the lateral side. C and D, Immediate postoperative radiographs.
Figure 4.
Figure 4.
A, A 63-year-old woman with type 3A open distal femur fracture with bone defect. A temporary mini-plate is used to hold reduction. A short retrograde nail is inserted, and both distal locking screws are drilled from medial to lateral. B, The first linking screw has been inserted through the distal-most nail locking hole. Owing to imperfection of the alignment between the plate screw hole and the proximal-most nail locking hole, linking with a second screw is facilitated with the use of a guide wire inserted from medial to lateral, followed by insertion of a cannulated screw from the distal femur plate system from lateral to medial.
Figure 5.
Figure 5.
Final fluoroscopic images of the case in Figure 4, demonstrating the 2 linking screws.
See this image and copyright information in PMC

References

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