Screw Density is Not Associated with Outcomes of Lateral Bridge Plating of Distal Femur Fractures

OBJECTIVE: To examine whether screw density was associated with reoperation to promote union in distal femur fractures fixed with lateral bridge plating. METHODS: Design : Systematic review, meta-analysis and retrospective clinical cohort Setting: Tertiary referral center Patient Selection Criteria: Systematic review and meta-analysis: PubMed, Embase, and Cochrane databases were systematically searched from the earliest available records of each database through May 2025. Included were observational studies and randomized controlled trials that reported the union rate following index distal femur fracture fixation with a single lateral distal femur plate and screw density of the lateral distal femur plate for groups that did and did not require a reoperation to promote union. Retrospective clinical cohort: Adult patients who underwent lateral single-plate bridge fixation for acute distal femur fracture (OTA/AO 33A and 33C) at a single institution from January 2017 to January 2024 were reviewed. Excluded were patients with pathologic fractures, interprosthetic fractures, missing records, and 0.05). Screw densities were not associated with re-operation to promote union (PSD 64.3% in those with re-operation and 55.6% in those without (p=.526), TSD (45.7% in those with re-operation and 52.0% in those without, p=.455). CONCLUSIONS: Based on both a meta-analysis and a clinical study, no association between screw density and reoperation to promote union in distal femur fractures fixed with a lateral single-plate bridging construct were found. Focus on parameters other than screw density are warranted in designing optimal bridge plate constructs. LEVEL OF EVIDENCE: A level III retrospective prognostic study