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“Biological plating”

In the past two decades, experience has shown that maintenance of the metaphyseal/diaphyseal soft-tissue attachments in comminuted fractures leads to higher rates of union. There may be surgical enthusiastic about reducing and performing lag screw fixation of small intermediate fragments on the medial aspect of the distal femur. However, in doing so, disruption of the normal healing process may result. Therefore, appropriate length, angulation and rotation should be obtained but there is no need to reposition and fix every small fragment in a comminuted fracture.
Provided the anatomical relationships of the main proximal and distal fragments are restored, and the biology of the comminuted metaphyseal zone is respected, satisfactory union is highly likely to occur.