Description
In a detailed presentation, Mike Gardner discusses the controversial topic of using nails versus plates for distal femur fractures. He highlights issues such as articular comminution, metaphyseal patterns, and the importance of implant choice in relation to bone quality and quantity. Gardner emphasizes the need for absolute stability in articular surface fixation and the necessity of restoring length, alignment, and rotation for optimal healing. He shares patient considerations for both implant types, including the effectiveness of lag screws and locking plates in different fracture patterns.
He reviews recent studies comparing outcomes of locking plates versus retrograde nails, noting findings on malreduction rates and nonunion rates, which favor nail fixation for functional outcomes. Gardner also presents case studies illustrating challenges and successes in surgical techniques, advocating for early weight-bearing and innovative use of implants. He concludes that while both methods have their pros and cons, the evolving technology in implants greatly assists surgeons in achieving positive patient outcomes.