Periarticular locking plates are now the mainstay for distal femur fractures due to their capacity to provide sufficient stability while preserving the blood supply [1]. As a bridging plate, locked plates can be applied to fractures with comminution and osteoporotic bones. However, there have been concerns regarding the stiffness of locked plates related to the suppression of healing. Henderson et al. reported a 20% nonunion rate in distal femoral fractures treated with locked plates [2]. They suggested that the primary problem was callus inhibition resulting from the stiffness of the fixation construct rather than hardware failure. Lujan et al. reported asymmetric callus formation in distal femur fractures fixed with locked plates and concluded that more flexible titanium plates enhanced callus formation compared to stainless steel plates [3].

To address stiffness of locked plates, the concept of far cortical locking (FCL) was introduced, which reduces the stiffness of the plate-screw interface and increases interfragmentary motion in the near cortex [4]. Bottlang et al. demonstrated satisfactory results using a FCL construct for distal femoral fractures in a pilot observational study involving 32 patients [5]. Wang et al. retrospectively compared FCL and standard locking systems [6]. They concluded that the FCL construct was beneficial for early callus formation, whereas the standard locking system was not inferior for final fracture healing. Meanwhile, one concern regarding the FCL system in the literature is the durability of constructs related to unicortical purchase. In addition, there are theoretical concerns regarding the possibility of healing suppression due to high strain loads with increased motion in simple fractures [7]. However, there have been no prospective studies surrounding the FCL system in Asian populations. This study aimed to demonstrate the clinical efficacy of the FCL system in treating distal femoral fractures in an Asian population.