Abstract
BACKGROUND: Periprosthetic distal femur fractures following total knee arthroplasty (TKA) are increasingly encountered and present considerable reconstructive challenges, with internal fixation remaining the mainstay of management. This retrospective comparative study examines the clinical and radiological outcomes of single locked plating versus dual plating in Rorabeck type I and II fractures. METHODS: A total of 45 patients treated between August 2017 and August 2024 were included (31 single plating; 14 dual plating). Functional outcome (Oxford Knee Score), union characteristics, weight-bearing timelines, and complications were compared. RESULTS: The study included 45 patients (30 females, 15 males), with a mean age of 67 ± 8.7 years. All fractures achieved union (100 % union rate) with a mean time to union of 4.4 ± 1.2 months. Dual plating achieved earlier fracture union (3.71 ± 1.35 months) and permitted earlier full weight-bearing (3.18 ± 1.22 months) compared with single plating (4.77 ± 0.85 months and 4.18 ± 0.84 months, respectively). Dual plating yielded significantly better functional outcomes than single plating, with progressively higher Oxford Knee Scores at 1, 3, and 6 months of follow-up (p < 0.05). Complication rates were comparable between groups (superficial infection 3 cases; deep infection 1; delayed union 3; malunion 1). CONCLUSION: Dual plating is better than single locked plating for such injuries, as it provides a stable construct, anatomical reduction, early fracture union, early mobilization, excellent outcomes, and minimal complications.