Functional And Radiological Outcome of Distal Femur Fracture Using Retrograde Nail or Plate Osteosynthesis – An Observational Study

Abstract

Background: Distal femur fractures are complex injuries associated with significant morbidity and functional impairment. Although both retrograde intramedullary nailing and locking plate fixation are widely used, the optimal fixation method remains controversial because of differences in fracture characteristics, implant biomechanics, and postoperative outcomes. The present study compared the functional and radiological outcomes of distal femur fractures managed with retrograde intramedullary nailing and locking plate osteosynthesis.

Aim: To compare the functional and radiological outcomes of distal femur fractures treated with retrograde intramedullary nailing and locking plate fixation.

Materials and Methods: LA prospective observational comparative study was conducted in the Department of Orthopaedics, Sree Balaji Medical College and Hospital, Chennai, over an 18-month period. Thirty adult patients with distal femur fractures underwent surgical fixation using either retrograde intramedullary nailing (n=15) or locking plate osteosynthesis (n=15). Patients were followed for six months. Outcome measures included operative duration, intraoperative blood loss, time to fracture union, postoperative pain assessed using the Visual Analogue Scale (VAS), knee range of motion, radiological union, functional recovery, postoperative complications, and regression analysis of factors influencing outcomes. Statistical significance was considered at p<0.05.

Results: The mean age of the study population was 48.4 ± 12.45 years, and 76.7% of patients were male. Road traffic accidents accounted for 60% of injuries. Retrograde intramedullary nailing demonstrated significantly shorter operative duration (101.2 ± 18.3 vs. 118.7 ± 19.8 minutes; p=0.031), lower blood loss (287.6 ± 58.2 vs. 342.5 ± 62.4 mL; p=0.022), and earlier fracture union (10.9 ± 5.9 vs. 12.8 ± 6.9 weeks; p=0.041) than locking plate fixation. Final knee flexion was significantly greater in the retrograde nail group (118.0 ± 8.6° vs. 108.0 ± 10.2°; p=0.048), while postoperative pain scores were significantly lower (1.3 ± 0.6 vs. 1.9 ± 0.8; p=0.035). Overall fracture union rates were 93.3% and 86.7% in the retrograde nail and locking plate groups, respectively. The locking plate group exhibited relatively higher rates of delayed union, implant failure, infection, and knee stiffness. Smoking, increased body mass index, and prolonged fracture union adversely influenced postoperative outcomes.

Conclusion: Both retrograde intramedullary nailing and locking plate fixation provide satisfactory clinical and radiological outcomes in distal femur fractures. However, retrograde intramedullary nailing demonstrated superior operative efficiency, earlier fracture union, improved postoperative knee function, lower pain scores, and fewer complications. Implant selection should be individualized according to fracture configuration, bone quality, and patient characteristics to optimize functional recovery.