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Fixation of a comminuted mid-distal femur fracture is challenging in clinical practice due to a high degree of comminution and malformation. Here we describe a procedure involving a series of steps for accurate fracture fixation in a patient diagnosed with comminuted mid-distal femur fracture. Emergency traction of the tibia tubercle was initially performed using a large distractor for temporary external fixation to maintain the femoral force line and to reduce intraoperative fractures. A three-dimensional printed model was then used as a preoperative simulation tool to preshape the customized locking plate, reducing the operation difficulty and improving surgical accuracy. Finally, the comminuted femur fracture was treated with the minimally invasive percutaneous plate osteosynthesis technique for maximum protection of bone fracture fragments and the surrounding blood supply. No postoperative complications were observed at the 3-year follow-up when the plate was removed. This procedure offers new possibilities for orthopedic surgeries and should be considered as an option for accurate fixation of comminuted mid-distal femur fractures.

Accurate fixation of complicated comminuted femur fracture with customized LCP referencing a life-size 3D-printed model: a case report