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.