Comparative outcomes of Retrograde Intramedullary Nailing versus Locked Plating in the treatment of Distal Femur Fractures

Abstract Background: Distal femur fractures, although rare, pose significant clinical challenges. This study compares the clinical, radiological, and functional outcomes of retrograde intramedullary nailing (Group IN) versus locked plating (Group LP) for treating extra-articular distal femur fractures. Methods: A prospective randomized study was conducted at Maharajah's Institute of Medical Sciences from January 2023 to June 2024, involving 40 patients aged 18 to 60 years. Patients were assigned to Group LP (locked plating) or Group IN (retrograde intramedullary nailing). Clinical outcomes, including flexion scores, time to full weight-bearing, union times, and complications, were evaluated. Results: Group IN demonstrated significantly higher flexion scores (p = 0.029) and a shorter time to full weight-bearing (p = 0.004) compared to Group LP. The mean union time for Group IN was significantly shorter at 11.5 weeks versus 16.0 weeks for Group LP (p = 0.0006). However, Group IN experienced higher postoperative pain scores (p < 0.001). Operative times were comparable (Group IN: 104 minutes; Group LP: 116 minutes; p > 0.05). Conclusion: Retrograde intramedullary nailing offers significant advantages in functional recovery and union times compared to locked plating for extra-articular distal femur fractures. Nonetheless, the increased incidence of knee pain in Group IN highlights the need for careful patient selection. Further research with larger cohorts is needed to validate these findings and assess long-term outcomes.