SUMMARY
This study was to compare the relative strength of fixation and clinical outcomes of unilateral and bilateral plating of comminuted distal femoral fractures. Eight matched pairs of embalmed cadaveric femurs were selected. A gap osteotomy was created to stimulate an AO/OTA A3 fracture. One femur of each pair was fixed with a locking plate; the other, with a locking plate and a medial plate. Nondestructive axial compression and maximum load to failure test were performed. Significantly greater axial displacement occurred with the UPG than with the BPG. In load-to-failure testing, the peak load was 2568± 452 N, and 3822± 567 N, respectively. A total of 52 patients were divided into unilateral plating group (UPG) and bilateral plating group (BPG). There was no significant difference between UPG and BPG in terms of blood loss, time to union, complication rate, Visual analog score, range of motion and Neer knee score. Bilateral plating proved stronger than unilateral plating in biomechanical testing; however, bilateral plating was not superior to unilateral plating in clinical outcomes. Therefore, we do not recommend bilateral plating as a routine fixation of comminuted distal femoral fractures.