Distal femur fractures: a comparison of hybrid and non-hybrid fixation of standard locking plates

Aims

The aim of the study was to assess progression of fracture healing after locking plate osteosynthesis with hybrid fixation compared with non-hybrid fixation in the distal femur, using the modified Radiological Union Scale for Tibia (mRUST) fracture score.

Methods

A retrospective review was performed to identify patients who had operative fixation of distal femur fractures with a distal femoral locking plate. A total of 90 patients with 90 fractures (26 hybrid and 64 non-hybrid) were included for analysis. The primary outcome was to compare two constructs using mRUST score assessed on anteroposterior (AP) and lateral radiographs at six, 12, and 24 weeks, and final follow-up.

Results

Overall, 90 patients with distal femur fractures with a mean age of 53 years (SD 24.4) met the inclusion criteria. Statistically significant differences in mean mRUST scores were noted at six weeks (p < 0.001), 12 weeks (p < 0.001), and 24 weeks (p < 0.001) postoperatively, with higher mean scores in the hybrid group. However, there was no significant difference in the union rate or other complication rates between the two groups. The union rate was 100% and 97% for the hybrid and non-hybrid groups, respectively, at final follow-up.

Conclusion

This study suggests that standard locking plates with hybrid fixation form earlier bridging callus than locking plates with non-hybrid fixation. However, there were no differences in final follow-up including healing rates or complications between the two groups. Further prospective study designs are needed to compare the two constructs in distal femur fracture, which is necessary to improve the results and provide the optimal healing environment for distal femur fractures.

Cite this article: Bone Jt Open  2026;7(6):809–817.