03/10/2026
The saying “better lucky than good” often applies to severe injuries where a successful outcome often depends on many factors outside a surgeon’s control. In my experience, it’s often by the sheer grace of God that a patient pulls through tough injury without major complications.
In this example from , a patient was involved in a high-speed motorcycle crash and sustained a highly comminuted type IIIA open intra-articular distal femur fracture. In the absence of additional injuries and any gross contamination, the decision was made to proceed with immediate definitive fixation after standard debridement and irrigation, attempting to preserve soft tissue attachments to the comminuted metaphyseal fragments.
After reducing the major articular components, a definitive distal femoral locking plate was applied while using a bone hook to control articular bloc sagittal plane alignment and a colinear clap to control coronal plane reduction. The decision was made to not perform additional fixation (medial plate, IM nail) to preserve future reconstructive options in case nonunion or infection occurred.
Given the comminution, there was an expectation of possible delayed bone grafting but at six weeks, with early callus noted, we decided to ride it out without further intervention and at six months, the fracture has completely healed / remodeled. No further interventions required. This is consistent with a 2013 JOT article from showing better results with limited versus aggressive debridement. While dual plating, nailing, or nail-plate constructs are becoming more common, it’s still possible to treat these injuries with a single lateral plate if adhering to basic principles. Curious to see how others would have tackled this injury!
Lastly, a huge thank you and shout out to for giving me permission to share his pictures / story and for being a resilient patient to the end. Keep up the hard work 💪👍
