Comparative Study of Distal Femoral Locked Plate Versus Retrograde Intra-Medullary Nailing in Fixation of Extra-Articular Distal Femur Fracture

Abstract

Background

Extra-articular distal femoral fractures require stable fixation to restore alignment, promote union, and preserve knee function. Locked plating (LP) and retrograde intramedullary nailing (RIMN) are commonly used, although their relative clinical advantages remain uncertain.

Aim

To compare the operative, radiological, and functional outcomes of LP and RIMN in adults with extra-articular distal femoral fractures.

Patients and Methods: This retrospective comparative study included 98 patients aged 18–60 years with closed extra-articular distal femoral fractures treated at October 6 University Hospital between 2021 and 2025. Patients underwent LP (n = 58) or RIMN (n = 40). Operative duration, blood loss, postoperative pain, knee range of motion, weight-bearing ability, functional recovery, fracture union, deformity, reoperation, and complications were compared.

Results: LP patients were older (43.03 vs. 37.95 years, P = 0.016), with significantly different fracture morphology (P < 0.001). RIMN was associated with shorter operative duration (107.50 vs. 124.05 minutes, P = 0.003), lower blood loss (444.00 vs. 922.93 mL, P < 0.001), and lower median pain scores (1.5 vs. 2, P < 0.001). Bridging callus was more frequent after RIMN (95% vs. 22.41%, P < 0.001), with shorter mean union time (12.78 vs. 14.21 weeks, reported P = 0.044). Deformity patterns differed significantly (P = 0.015). Functional recovery, knee motion, weight-bearing ability, reoperation, and overall complication distributions showed no significant differences (all P > 0.05).

Conclusion: Both LP and RIMN achieved comparable recorded functional outcomes. RIMN showed favorable operative and healing outcomes, although baseline differences in age and fracture morphology limit causal interpretation.