Lateral Distal Femur Plate for Periprosthetic Fracture.

In this case, a lateral locking plate is used for fixation of a periprosthetic distal femur fracture in a 68-year-old woman. Modern implants with locking screw options and soft-tissue-sparing surgical techniques have improved the care of periprosthetic distal femur fractures. Although much debate about the working length and technical variables of plating exists, it is generally accepted that longer (>10 hole) plates with adequate working length and careful soft-tissue handling are preferred. This case outlines a stepwise approach to distal femur fractures to achieve appropriate plate position and restoration of alignment while avoiding excessive surgical exposure or soft-tissue dissection. In this case, retrograde intramedullary nail was not considered because of the distal nature of the fracture, but this option may be favorable for cruciate-retaining total knee arthroplasty or open box designs that will accommodate nail insertion. Although weight bearing was protected for 6 weeks, plate fixation allows early rehabilitation and knee range of motion. This patient went on to successful union and excellent clinical outcome with return to baseline function.