Single Lateral Plate Versus Double Plating for the Fixation of Distal Femoral Fractures

A Comparative Analysis of Single Lateral Plate Versus Double Plating for the Fixation of Distal Femoral Fractures: A Randomized Clinical Trial

This trial aimed to provide Level I evidence on the comparative effectiveness, safety, and functional outcomes of single versus double plating for distal femoral fractures.

Distal femoral fractures, particularly those with metaphyseal comminution, present a significant surgical challenge with high risks of nonunion, malalignment, and functional impairment.

The single lateral locking plate (SLP) is a common fixation method but may lack sufficient stability in complex fractures, leading to varus collapse.

Dual plating (lateral and medial plates) offers enhanced biomechanical stability but involves greater surgical invasiveness.

Inclusion Criteria:

• Age ≥ 18 years.
• Acute, displaced, closed or Gustilo-Anderson Type I open distal femoral fracture (AO/OTA types 33-A1, A2, A3, C1, C2, C3).
• Presentation within 7 days of injury.
• Provision of written informed consent.

Exclusion Criteria:

• Pathological fractures.
• Associated ipsilateral lower extremity trauma (floating knee).
• Associated neurovascular injury requiring repair.
• Pre-existing symptomatic knee arthritis or prior major knee surgery.
• Active local or systemic infection.
• Medical comorbidities precluding surgery or anesthesia [American Society of Anesthesiologists (ASA) class IV/V].
• Cognitive impairment or inability to comply with follow-up.