Clinical outcomes of far cortical locking constructs in distal femur fractures: a systematic review and meta-analysis.

Abstract

Distal femur fractures commonly occur in elderly and osteoporotic patients and are associated with difficult healing and a high risk of reoperation. Far cortical locking (FCL) is a locking plate strategy designed to reduce construct stiffness, allow controlled motion at the fracture gap, and support secondary bone healing. This systematic review and meta-analysis had two objectives to compare clinical and radiographic outcomes of FCL and standard locking plate (SLP) constructs in adult distal femur fractures, and to describe healing, complication, and revision rates in published FCL cohorts. A systematic search was performed in PubMed, Web of Science, Scopus, and Embase up to February 2025 for randomized controlled trials and cohort studies comparing FCL and SLP. Data extraction, quality assessment (using Cochrane ROB and ROBINS-E tools), and statistical analyses were performed using Review Manager (RevMan) version 5.4.1. Five studies (n = 326; 208 FCL, 118 control) were included. At 3 months, FCL had significantly higher RUST scores than SLP (SMD = 0.60, 95% CI 0.16-1.04, P = 0.007). By 6 months, no significant difference remained. No notable differences were found in postoperative complications, revision, or mortality. Among FCL-only cohorts, RUST scores increased over time, with a 7.2% revision rate and 78.2% radiologic healing by 6 months. FCL is associated with earlier radiographic callus appearance compared with SLP constructs in the early phase of healing, but longer term outcomes appear similar. At this stage, FCL can be considered a potential option in selected cases, but its role has not been clearly defined, and further adequately powered randomized studies are required to confirm indications and clarify its clinical impact.