Results of Double Plating for Distal Femoral Fracture Fixation Using a Single Approach: A Retrospective Study

Background: Distal femoral fractures are complex injuries with high rates of comminution and intra-articular extension. In cases with medial cortex deficiency, single lateral plating may be insufficient, risking varus collapse. Double plating offers enhanced stability, but the optimal surgical approach remains a topic of debate. This study assessed outcomes of double plating via a single anterior approach with medial parapatellar arthrotomy. Patients and methods: A retrospective review was conducted of 37 patients (28 males, 9 females; mean age 47 ± 9.5 years) treated between May 2021 and May 2024. All underwent fixation with a lateral distal femoral locking plate and a medially contoured plate through a single anterior incision. Functional outcomes were measured using Sander's Functional Evaluation Score; union was defined radiographically as bridging callus in ≥3 cortices. Results: Mean follow-up was 20.6 ± 4.0 months. All fractures united, with a mean union time of 7.2 ± 1.2 months; two patients (5.4%) had delayed union requiring bone grafting. The mean Sander’s score improved from 17.9 ± 2.6 at 3 months to 36.8 ± 1.1 at final follow-up (p < 0.01), with 70.3% excellent, 10.8% good, 13.5% fair, and 5.4% poor results. Complications occurred in 21.6% of patients, including delayed union, superficial/deep infection, and knee stiffness. No implant failures, malunions, or varus collapse were observed. Conclusion: Double plating via a single anterior approach achieves rigid fixation, enables early mobilization, and achieves high union rates with favorable functional outcomes in complex distal femoral fractures, particularly those with medial comminution or intra-articular involvement.