Guide Plate Technique versus Fluoroscopy-Guided Technique in the Fixation of AO/OTA 33-C Distal Femur Fractures Using a Nail–Plate Dual System: A Retrospective Comparative Study

Introduction AO/OTA 33-C-type femoral fractures pose a significant clinical challenge for orthopedic surgeons. The nail–plate construct (NPC) has emerged as the predominant surgical strategy for these complex peri- and intertrochanteric fractures. However, to mitigate component interference within the implant construct, two nail–plate construct (NPC) techniques have been developed: a dedicated surgical guide device–assisted technique (NPC-GD) and a fluoroscopy-guided technique (NPC-GF).This study aimed to compare surgical outcomes, quality of life, and functional recovery in patients of AO/OTA 33-C-type femoral fractures using either NPC-GD or NPC-GF. Materials and methods A retrospective review of clinical data was conducted for patients diagnosed with AO/OTA 33-C-type femoral fractures who underwent dual-construct fixation—comprising both a locking plate and an intramedullary nail. Outcomes assessed included operative time, length of hospital stay, intraoperative and postoperative blood loss, number of intraoperative fluoroscopic images, incidence of malunion, time to radiographic fracture union, time to initiation of partial and full weight-bearing, final knee range of motion, and the Hospital for Special Surgery (HSS) knee score. Results The final analysis included 161 patients: 86 in the NPC-GD group and 75 in the NPC-GF group. NPC-GD group exhibited significantly shorter operative time (P = 0.006), lower intraoperative (P = 0.004) and postoperative (P = 0.003) blood loss, fewer intraoperative fluoroscopic images (P = 0.034), shorter time to radiographic fracture union (P = 0.037), earlier initiation of ambulation at final follow-up (P = 0.001), earlier achievement of full weight-bearing (P = 0.009), greater final knee range of motion (P = 0.009), and higher Hospital for Special Surgery (HSS) knee scores (P = 0.002). Conclusions Compared with NPC-GF, NPC-GD demonstrates superior clinical outcomes in the management of AO/OTA 33-C-type femoral fractures—specifically with respect to reduced operative complexity, diminished surgical trauma, accelerated fracture healing, and enhanced functional recovery.