Nail and Plate Combination Fixation for Distal Femur Fractures: Critical Narrative Review
Abstract: Background: A retrograde nail combined with a lateral plate may permit early loading in selected distal femur fractures, but comparative clinical evidence is mainly observational. Objective: To critically assess whether nail and plate combination (NPC) fixation improves construct survival and mobility compared with a lateral locked plate (LLP) or retrograde intramedullary nail (rIMN). Methods: A focused narrative review centered on a 2026 Journal of Orthopaedic Trauma cohort and selected original comparative studies. No systematic search or meta-analysis was performed. Results: In the 2026 cohort, construct failure occurred in 1 of 83 NPC fractures, 2 of 37 rIMN fractures, and 15 of 76 LLP fractures. Immediate weight bearing was permitted in 70%, 32%, and 3%, respectively. The association between NPC and fewer failures than LLP persisted in a limited adjusted analysis, but the confidence interval was wide. Other retrospective studies favored NPC for some healing and mobility endpoints; a multicenter randomized trial compared LLP with rIMN but did not test NPC. Conclusion: NPC is a plausible option when a single implant is judged insufficient or early loading is especially valuable. Current evidence does not prove a universal causal advantage, nor does it establish that every NPC can safely permit immediate unrestricted loading.
Keywords: distal femur fracture; nail and plate fixation; retrograde nail; lateral locked plate; construct failure; weight bearing
How to Cite?: Nishant, "Nail and Plate Combination Fixation for Distal Femur Fractures: Critical Narrative Review", Volume 15 Issue 10, October 2026, International Journal of Science and Research (IJSR), Pages: 500-502, https://www.ijsr.net/getabstract.php?paperid=SR261007151523, DOI: https://dx.doi.org/10.21275/SR261007151523