A comparison of three operative treatments of distal femoral fractures

Abstract

Objective To compare anterograde intramedullary nailing (AIN),retrograde intramedullary nailing (RIN) and locking compression plating (LCP) in the treatment of distal femoral fractures.Methods The clinical data were reviewed of 85 patients with distal femoral fractures who had been treated in our department between January 2005 and December 2009.They were 46 males and 39 females,15 to 58 years old (average,38.8 years old).According to the fixation they were divided into 3 groups:AIN (n =17),RIN (n =42) and LCP (n =26).They were compared in terms of operation time,bleeding volume,functional recovery of the knee and complications.Results They were followed for 12 to 24 months (average,18 months).All patients obtained bone union within 6 months except one case of nonunion.In terms of operation time and bleeding volume,AIN and RIN were significantly better than LCP,and AIN significantly better than RIN too (P ＜ 0.05).The good to excellent rate of functional recovery was 58.8％ (10/17) for AIN,88.1％ (37/42) for RIN and 69.2％ (18/26) for LCP; RIN was significantly superior to AIN (P ＜ 0.05).The rate of postoperative complications was 11.8％ (2/17) for AIN,9.5％ (4/42) for RIN and 7.7％ (2/26) for LCP,with no significant between-group difference(P =1.000).Conclusion RIN has advantages of accurate alignment,rigid immobilization,shorter operation time,less bleeding volume,and better functional recovery of the knee over AIN and LCP in the treatment of distal femoral fractures. Key words: Femoral fractures; Fracture fixation, internal; Bone nails; Bone plates