Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’

Abstract

Abstract Purpose The reconstruction of complex distal femur fractures with bone loss is a surgical challenge. The aim of the present study was to evaluate the effectiveness of the ‘three-in-one’ surgical technique, which combines a retrograde nail linked to a lateral locked plate with defect reconstruction using a bone graft in a synthetic scaffold. Materials and Methods A prospective study was conducted at a level 1 trauma centre from 2016 to 2021. Comminuted distal femur fractures (OTA/AO type 33A3, 33C2, or 33C3) with bone loss in skeletally mature patients were included. The ‘three-in-one’ surgical technique was used in all cases. Results The present study comprised 14 cases with a mean age of 28 years (range, 18–58 years). The bone defect sizes ranged from 3 to 8 cm. Ten cases (71%) had open fractures. Operative duration ranged between 150 and 210 min (Average 175 min). Excellent, good and fair outcomes according to sanders score were achieved in eight (57%), five (36%) and one case (7%), respectively. There were no cases of implant failure or varus collapse. Postoperative follow-up ranged from 12 to 53 months (mean 27 months). Conclusion Management of complex distal femur fractures using the ‘three-in-one technique’ (retrograde nail fixation augmented by anatomical lateral locked plate and reconstruction of the bone defect using autologous bone grafts in a scaffold of synthetic oxidised cellulose gauze) for complex distal femur fractures provides a stable biomechanical construct that allows fracture healing and early rehabilitation in a single stage through a single approach.