This patient has a 33-C2 fracture. The fracture extends very distally leaving a small distal segment. The distal segment is also split. The metaphyseal comminution extends over a long distance. This is a high energy pattern with significant injury to the local biology. The treatment plan needs to take all of this in to account.
The DCS would not be the best option because the distal segment is so small. A fixed angle blade plate can be used but it is technically more difficult to place. A condylar buttress plate could be used but would be prone to failure due to the medial comminution. It would also require the use of a medial column support, i.e., a medial plate. This would interfere with the local biology more than necessary. The distal segment is to small for a retrograde nail. A total knee replacement is a salvage for older patients. In addition, this patient would require modular distal femoral replacement; a huge surgical procedure.
What ever implant is chosen, biologic plating techniques are required. This would involve bypassing the comminuted metaphyseal zone after reduction of the articular surface. The addition of bone graft would require a dissection that would interfere with the local blood supply. Biologic plating techniques without bone graft would be the best option.
A locking condylar plate creates a blade plate like construct and is less technically difficult to insert. The screws have threads on the head that lock into threads in the plate hole. The plate holes are angled so that multi-planer fixation is achieved. The screws are cannulated and placed over temporary fixation guide wires. Screws are also available with conical heads to provide compression in the distal plate holes. There are locking holes proximally in the plate as well.