In the treatment of unstable, distal, metaphyseal femoral fractures, surgeons have multiple implant options for fixation. Biomechanical studies of intramedullary nailing systems and locking plates have shown that both systems achieve stable fixation of the fracture to allow healing.1–3 These systems are indicated for comminuted fractures, non-unions, and osteoporotic bone where distal femur fractures are associated with a 20% mortality rate in elderly individuals.4 Though capable of achieving stable fixation, both locking and non-locking plates have been associated with periprosthetic fractures in osteoporotic and normal bone.4–6 A recent clinical study reported a 2.6% incidence of periprosthetic fractures at the locking plate end.7

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