Carlos Ballesteros Ponce

Distal femur fractures with significant lateral comminution often challenge single-implant fixation, particularly in osteoporotic or high-energy cases. This technical note describes a reproducible method combining a retrograde femoral nail with a lateral LCP (LISS-type) plate using the Conflict-Free Screw Map, a predefined system of safe plate holes (A and B) that align with the distal interlocking bolts of the nail and prevent implant collision. After provisional reduction, the retrograde nail is inserted but left without distal locking, allowing submuscular placement of the lateral plate beneath vastus lateralis. Once the plate is secured following the conflict-free map, definitive distal nail locking is completed, creating a load-sharing, torsion-resistant construct without the need for medial augmentation. Seven patients (mean age 72 years, OTA/AO 33-A3, C2, C3) were treated between 2021 and 2024 using this technique. The mean operative time was 2 hours 20 minutes, and all fractures achieved radiographic union at a mean of 12 weeks (10–16). No infections, mechanical failures, or screw conflicts occurred, and mean final knee motion was 0–115°. The Conflict-Free Screw Map simplifies implant coexistence, reduces surgical exposure, and enhances reproducibility of dual-implant constructs. This nail–plate configuration provides a stable, biologically friendly solution for distal femur fractures with lateral comminution, allowing early mobilization and consistent union outcomes. Level of Evidence: Level V (Technical Note).

Vitamin C, a potent reducing and antioxidant agent, plays an important role in the body, aiding in the growth of cartilage and bones. It is also involved in mechanisms that help reduce inflammation and its effects on the body. In addition, vitamin C decreases pro-inflammatory cytokines, such as IL-6, which produce acute-phase proteins such as CRP and influence inflammatory markers such as ESR. We carried out a study with 110 patients who underwent total knee replacement surgery. We divided the patients into two groups, in which the intervention group received 15 g of parenteral vitamin C during the immediate postoperative period while the control group did not. Patients who received 15 g of vitamin C after total knee replacement surgery had decreased inflammatory markers, specifically CRP and ESR. Overall, administering vitamin C in the post-surgical period results in improved management of inflammation, as evidenced by a decrease in CRP and ESR values. This leads to faster recovery and better healing outcomes for patients undergoing total knee replacement surgery. Furthermore, the beneficial effects of vitamin C in reducing proinflammatory cytokines, reducing the need for opioid analgesics, and its mild adverse effects make it a promising adjuvant in managing postoperative recovery.