Comparison of Functional Outcome and Union of Distal Femoral Fractures with Metaphyseal Comminution Fixed with a Single Distal Femoral Locking Plate Versus a Dual Plate

Muhammad Imran Haider; Adnan Nazir; Kashif Siddiq; Muhammad Ishfaq Mazari; Muhammad Asad Munir; Muhammad Ishaq

doi:10.54112/bcsrj.v7i4.2279

Authors

Muhammad Imran Haider Department of Orthopaedic Surgery, Unit. 2. Nishtar Hospital Multan, Pakistan
Adnan Nazir Department of Orthopaedic Surgery, Unit 2, Shaikh Zayed Hospital, Rahim Yar Khan, Pakistan
Kashif Siddiq Department of Orthopaedic Surgery, Orthopaedic, Bahawal Victoria Hospital, Bahawalpur, Pakistan
Muhammad Ishfaq Mazari Department of Orthopaedic Surgery, Unit 2, Shaikh Zayed Hospital, Rahim Yar Khan, Pakistan
Muhammad Asad Munir Department of Orthopaedic Surgery, Unit 2, Shaikh Zayed Hospital, Rahim Yar Khan, Pakistan
Muhammad Ishaq Department of Orthopaedic Surgery, Unit 2, Shaikh Zayed Hospital, Rahim Yar Khan, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v7i4.2279

Keywords:

Femoral Fractures, Fracture Fixation, Internal, Bone Plates, Fracture Healing, Treatment Outcome, Range of Motion, Articular

Abstract

Distal femoral fractures with metaphyseal comminution are difficult injuries because medial cortical deficiency may compromise fixation stability, delay union, and impair knee function. Although single lateral distal femoral locking plate fixation is widely used, dual plating may provide additional medial column support and improve mechanical stability in highly comminuted fracture patterns. Objective: To compare radiological union and functional outcomes of distal femoral fractures with metaphyseal comminution treated with single lateral distal femoral locking plate fixation versus dual plating using a lateral distal femoral locking plate combined with a medial T-plate. Methods: This comparative clinical study was conducted at the Department of Orthopaedic Surgery at Nishtar Hospital, Multan, from July to December 2025. A total of 90 adult patients with distal femoral fractures with metaphyseal comminution were included and divided into two equal groups: 45 patients underwent fixation with a single lateral locking plate, and 45 underwent dual plating. Eligible fracture patterns included AO/OTA 33-A3, 33-C2, and 33-C3 fractures. Outcomes included radiological union, time to union, weight-bearing status, varus malalignment, implant failure, knee range of motion, Knee Society Score, Lower Extremity Functional Scale score, and postoperative complications. Data were analyzed using SPSS version 26, with p<0.05 considered statistically significant. Results: Baseline demographic and fracture-related characteristics were comparable between groups. Dual plating was associated with significantly longer operative time and greater blood loss; however, it allowed earlier partial weight-bearing and full weight-bearing. Radiological union was achieved in 95.6% of patients in the dual-plate group compared with 84.4% in the single-plate group. Mean time to union was significantly shorter with dual plating. Varus malalignment was significantly lower in the dual-plate group. Functional outcomes were also superior after dual plating, with higher knee range of motion, Knee Society Score, Lower Extremity Functional Scale score, and a greater proportion of excellent or good outcomes. Overall complication rates did not differ significantly between groups. Conclusion: Dual plating provided better mechanical stability, earlier weight-bearing, faster union, improved alignment, and superior functional recovery compared with single lateral locking plate fixation in distal femoral fractures with metaphyseal comminution. Although dual plating increased operative time and blood loss, it did not significantly increase overall complications. It may be considered a more effective fixation strategy in selected comminuted distal femoral fractures.

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