• Yanin Plumarom, Brandon G Wilkinson, J Lawrence Marsh, Michael C Willey, Qiang An, Yubo Gao, and Matthew D Karam.
• Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA.
• J Orthop Trauma. 2019 Jun 1; 33 (6): 277-283.

ObjectivesTo investigate the radiographic healing of far cortical locking (FCL) construct fixation in distal femur fractures compared with traditional locking plate (LP) constructs.DesignA retrospective cohort of 143 consecutive patients with 146 distal femur fractures.SettingLevel I trauma center.Patients/ParticipantsAfter excluding patients with OTA/AO type B fractures, referred nonunion cases, patients younger than 16 years, and patients with less than 24 weeks of follow-up, 69 patients with 70 total fractures were included for analysis.InterventionAP and lateral knee radiographs were blinded to type of screws and individually reviewed by 3 orthopaedic trauma surgeons.Outcome MeasurementsThe modified RUST (mRUST) score was our primary outcome measure. mRUST scores were assigned at 6, 12, and 24 weeks and final follow-up based on AP and lateral radiographs and compared between FCL and LP groups as a tool for evaluating fracture healing. Secondary outcomes compared between FCL and LP included union rate and postoperative complications.ResultsStatistically significant differences in mRUST scores were noted between FCL and LP groups at 6 weeks (P = 0.040), 12 weeks (P = 0.034), 24 weeks (0.044), and final follow-up (P = 0.048). There was no significant difference in union or specific complication rates between the 2 groups. The union rate was 90.5% and 82.1% for the FCL and LP groups, respectively, at final follow-up.ConclusionsTo our knowledge, this is the first comparative study between FCL and LP constructs. The FCL group was noted to have significantly higher mRUST scores at all periods indicating increased callus formation, but the differences seen were small and there were no differences in healing rates or complications between the 2 groups, thus bringing the clinical benefit of FCL into question. Further prospective study designs are needed to compare FCL with LP constructs and to investigate the role of interfragmentary motion on callus formation in distal femur fractures.Level Of EvidenceTherapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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