Analysis of Postoperative Knee Dysfunction Following a Distal Femur Fracture Managed by Different Surgical Methods

Background Distal femur fractures, in particular, are complicated injuries that have a major effect on knee biomechanics and functionality. As all fractures primarily affect older females from low-energy falls and younger males from high-energy injuries, patients treated with open reduction-internal fixation (ORIF) and intramedullary nailing (IMN) had their postoperative knee dysfunction and functional results assessed in this study. Objective This study aimed to analyze postoperative knee dysfunction and functional outcomes following distal femur fracture managed by ORIF and IMN and to evaluate functional outcomes, range of motion (ROM), muscle strength, and functional recovery. Methods A cross-sectional study was conducted with 108 patients (54 ORIF, 54 IMN) who had distal femur fractures and were at least 18 years old. Demographic data, injury details, and surgical approaches were recorded. Outcomes included ROM, muscle strength, limb length, and girth measurements. Complications like stiffness, shortening, extensor lag, and functional outcomes (Schatzker and Lambert criteria) were assessed. Result Multiple dysfunctions were identified despite successful surgical fixation. Knee stiffness was the most frequent limitation, followed by quadriceps wasting and gait deviations. Extensor lag and limb shortening were also noted in a significant subset. Gait abnormalities were observed in some patients, most commonly antalgic gait and knee flexion avoidance gait. Functional outcome assessment revealed a significantly higher rate of excellent results in the IMN group. ORIF has been associated with increased rates of infection and knee stiffness. Conclusion This study highlights that postoperative knee dysfunction, including stiffness, quadriceps weakness, extensor lag, and gait deviations, is common following distal femur fracture surgeries, regardless of fixation type. Early mobilization and proper fixation techniques are crucial for recovery. IMN provides better functional outcomes and fewer complications compared to ORIF for supracondylar femur fractures.