Supracondylar Distal Femur Fracture Fixation: Early Experiences Comparing the Retrograde Nail With Locking Attachment Washer (LAW) Plate to Traditional Fixation Techniques.

Abstract

The locking attachment washer (LAW) plate offers an advancement in fixation techniques for supracondylar distal femur fractures. This study compared fixation outcomes for supracondylar distal femur fractures managed with traditional fixation techniques (ie, retrograde intramedullary nail, locking plate) versus DePuy Synthes RFN-ADVANCED Retrograde Femoral Nailing System incorporating the LAW plate. A retrospective single-center comparative analysis was conducted of adult patients with supracondylar distal femur fractures treated between December 2022 and December 2024. Patients were divided into two groups: (1) traditional fixation and (2) nail plate construct using retrograde femoral nail with LAW plate. Outcomes focused on surgical parameters, functional recovery, and clinical implications. Forty-five patients met inclusion criteria: 17 treated with traditional fixation, 28 with the LAW construct. Patients in the LAW group were significantly more likely to have an estimated 76.43-minute reduction in operative time compared to patients in the traditional group (<i>P</i> = .009). Hospital length of stay trended shorter with LAW (7.5 vs 15.2 days) but failed to achieve statistical significance in both univariate and multivariate analyses. Postoperative weight bearing was significantly more common with LAW (67.8% vs 23.6%, <i>P</i> = .032), and the rate of radiographic union trended lower with LAW but did not achieve statistical significance. The LAW construct demonstrated shorter operative times and earlier advancement in weight-bearing protocols, despite use in an older cohort. Radiographic union and complication rates were comparable. Potential advantages of the LAW construct lend to clinical and research opportunities for these complex injuries.