{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T09:30:02Z","timestamp":1758274202295,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"12","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,11,14]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:p>A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.<\/jats:p>","DOI":"10.1136\/bcr-2021-245362","type":"journal-article","created":{"date-parts":[[2021,12,1]],"date-time":"2021-12-01T11:15:40Z","timestamp":1638357340000},"page":"e245362","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Failure of dual plating in a complex open distal femur fracture as the result of major trauma"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9527-4324","authenticated-orcid":false,"given":"Thomas Robert William","family":"Ward","sequence":"first","affiliation":[{"name":"Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kanai","family":"Garala","sequence":"additional","affiliation":[{"name":"Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bryan","family":"Riemer","sequence":"additional","affiliation":[{"name":"Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"key":"2025082709061487000_14.12.e245362.1","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.2174\/1874325001711011277","article-title":"The epidemiology of adult distal femoral shaft fractures in a central London major trauma centre over five years","volume":"11","author":"Khan","year":"2017","journal-title":"Open Orthop J"},{"key":"2025082709061487000_14.12.e245362.2","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1016\/S0020-1383(00)80034-0","article-title":"The epidemiology of fractures of the distal femur","volume":"31 Suppl 3","author":"Martinet","year":"2000","journal-title":"Injury"},{"key":"2025082709061487000_14.12.e245362.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.02.014"},{"key":"2025082709061487000_14.12.e245362.4","first-page":"CD010606","article-title":"Interventions for treating fractures of the distal femur in adults","volume":"8","author":"Griffin","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082709061487000_14.12.e245362.5","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1302\/0301-620X.98B6.36826","article-title":"Nails or plates for fracture of the distal femur? 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