Retrograde nailing versus locked plating for distal femur fractures

Abstract

Purpose Two major therapeutic principles can be employed for the treatment of distal femoral fractures: Retrograde Intramedullary Nail (RIN) or locked plating (LP). Both operative stabilizing systems follow the principle of biological osteosynthesis. Intramedullary nailing protects the soft tissue envelope owing to its minimally invasive approach and closed reduction techniques better than distal femoral LP. The purpose of this study was to evaluate and compare outcome of distal femur fracture stabilization using RIN or LP techniques. Patients and methods In a prospective study from 2014 to 2015, we analyzed 30 patients with distal femur fracture who had been treated by RIN (15 patients) or LP (15 patients). The patients had a mean age of 49 years (20–85 years). Mechanism of injury was high-energy impact in 66.7% and low-energy injury in 33.3%. Fractures were classified according to Association for Osteosynthesis (AO) classification: there were 17 type A fractures and 13 type C1 fractures. Functional and radiological outcomes were assessed. Results Clinical and radiographic evaluation according to the functional score of Sanders and colleagues demonstrated that, in RIN group, one (6.6%) case was excellent, nine (60%) cases were good, and four (26.8%) cases were fair, whereas in locked compression plates (LCP) group; eight (53.2%) cases were good, four (26.8%) cases were fair, and three (20%) cases were poor. In RIN group, the average time of fracture union was 19.5 weeks, with a range of 12–28 weeks. Of 15 cases, 14 (93.4%) cases progressed to union, and one (6.6%) case had delayed union and need dynamization. In LCP group, average time was 27.65 weeks, with a range of 12–32 weeks. Of 15 cases, 12 (80%) cases progressed to union, one (6.6%) case had nonunion, and two (13.4%) cases had delayed union. Conclusion Both femoral retrograde interlocking nail and LCP of distal femur appear to have statistically insignificant differences regarding knee motion, pain, resuming function, and rate of need of second surgery. However, retrograde nail is preferable to LP in terms of operative time, blood loss, image intensifier exposure time, early appearance of callus, weight bearing, and shorter time required for full union.