The treatment of distal femur fractures with modern precontoured locked plating is complex and challenging. Complications including "golf club" deformity (excessive medialization of the articular block relative to the shaft) and nonunion have been widely reported in the literature. Commonly held principles to reduce malalignment include obtaining adequate imaging, obtaining and maintaining a reduction throughout the duration of the procedure, and ensuring proper plate application. Adjunctive techniques to assist in the application of these principles include the use of a radiolucent triangle with a well-placed bump, the use of an external fixator for provisional stabilization, the use of unicortical plates, and the use of crossing K-wires. It is important to understand the common pitfalls involved with distal femur plating and to maintain a wide array of techniques in your armamentarium to combat these challenges.
J Am Acad Orthop Surg. 2021;29(18):770-779. © 2021 American Academy of Orthopaedic Surgeons