Management of Extra-articular Distal Femoral Fractures Through Closed Reduction and Internal Fixation Using Minimally Invasive Plate Osteosynthesis Versus Retrograde Intramedullary Nailing: A Comparative Study

Both MIPO and RIMN are reliable methods for extra-articular DFFs, providing comparable rates of union and excellent functional outcomes. While a broader range of final coronal alignment was observed in the RIMN group, this did not compromise stable union or functional recovery. RIMN offers faster rehabilitation and earlier weight-bearing, but with a higher reported incidence of anterior knee pain. MIPO is associated with lower knee morbidity and may be a suitable alternative, particularly for patients in whom minimizing anterior knee symptoms is a key concern, despite its slower rehabilitation pathway. The choice should be tailored to the fracture pattern, bone quality, and patient needs.