PubMed^® Literature Review

Nonunion rates vary across studies but are generally considered modest when using lateral locked plating (LLP) techniques [1][2]. However, several factors have been identified that increase the risk of nonunion including high-energy fractures, intra-articular involvement, poor bone quality, severe comminution or bone loss [1], younger age groups [2], and specific mechanical construct characteristics related to overall rigidity [3].

The development of LLP has improved outcomes for distal femur fractures; however, there remains a subset of patients who experience nonunion despite these advancements [1]. In particular, Rodriguez et al. (2016) highlighted that certain construct characteristics associated with LLP fixation—specifically plate design/material—significantly influence the risk of nonunion independent of other variables such as number of proximal screws or plate length [3]. They found that stainless steel constructs had a higher rate of nonunion compared to titanium constructs (41% vs. 10%) indicating material properties play an essential role in fracture healing dynamics under LLP fixation strategies.

Wenger and Andersson's retrospective study on 191 consecutive patients treated with LLP revealed an overall low rate of nonunion at 4%, suggesting that when applied correctly and considering patient-specific factors such as age and open versus closed fracture status; LLP can be highly effective in achieving fracture union [2]. This study also noted younger patients had higher reoperation rates not directly correlated with nonunion but potentially indicative of more complex initial injuries or higher functional demands leading to complications.

On the other hand, dual plating (DP) techniques involving both medial and lateral plates have emerged as an alternative strategy purportedly offering biomechanical advantages over single lateral plating especially in cases with significant comminution or instability [1]. O'Neill et al.'s systematic review supports this notion by demonstrating favorable outcomes associated with DP including acceptable complication rates alongside good functional recovery metrics compared against previously published data on LLP alone [1].

In summary, while LP offers substantial benefits for managing distal femoral fractures concerning reducing the incidence of nonunion among other complications; individual patient factors along with specific surgical technique nuances significantly impact success rates. Evidence suggests utilizing materials like titanium over stainless steel may reduce risks inherently tied to construct rigidity under LLP modalities. Moreover, exploring DP options could further mitigate nonunion risks particularly within challenging clinical scenarios characterized by extensive bone damage or compromised stability.