The importance of understanding the local anatomy, pathoanatomy of the injury, and implant design cannot be overemphasized. Fracture morphology is often best characterized with a CT scan, allowing the optimal visualization of fracture planes and the selection of appropriate reduction strategies. For example, intraarticular fractures will typically require reduction and fixation before the stabilization of the metaphyseal segment. "Hoffa" fractures (coronal plane fractures of one or both condyles) are present in as many as 40% of distal femur fractures with intercondylar extension and merit reduction and fixation with anterior-to-posterior–directed screws before addressing the remainder of the injury.
Understanding the design of the intended implants is also important. Modern precontoured lateral locking plates are designed to reproduce the anatomic lateral distal femoral angle of 81° to 85° and permit the use of both locking and nonlocking screws. Nonlocking screws can facilitate the use of the plate as a reduction aid by first fixing the plate distally and drawing the shaft to the plate, or vice versa. Locking screws can be used for enhanced fixation in osteoporotic bone or to achieve adequate fixation in short distal segments, irrespective of bone quality.
J Am Acad Orthop Surg. 2021;29(18):770-779. © 2021 American Academy of Orthopaedic Surgeons