Distal Femur Plate Failed Fixation

This case is of a 75-year-old female who underwent open reduction internal fixation (ORIF) of a closed, extra-articular distal femur fracture at an outside hospital. She presented 6 months post-operatively with no signs of radiographic healing. The patient had a negative infectious and metabolic workup, and 9 months from initial ORIF she continued to have no signs of boney healing on radiographs or computed tomography (CT). She was diagnosed with an aseptic, atrophic nonunion secondary to use of a rigid, short segment initial construct with a fixed fracture gap. She elected to delay revision surgery, but at 11 months post-operatively she presented to the emergency department with atraumatic thigh pain. Radiographic evaluation revealed catastrophic hardware failure at the site of nonunion. The patient underwent revision ORIF with a combination construct of an intramedullary nail (IMN) supplemented with a lateral distal femur plate, creating a boxed construct with a transition of stiffness that allows secondary bone healing as well as immediate weight bearing. The patient had an uneventful post-operative course, achieving radiographic union and ambulating without assistance by 6 months from revision surgery.