Locked Lateral Plating vs. Retrograde Nailing for Distal Femur Fractures: A Prospective Multicenter Randomized Trial

OBJECTIVES: The main two forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment. DESIGN: Prospective, multicenter randomized controlled trial. SETTING: 20 academic trauma centersPatients/Participants: 160 patients with distal femur fractures were enrolled. 126 patients were followed 12 months. Patients were randomized to plating in 62 cases and to intramedullary nailing in 64 cases. INTERVENTION: Lateral locked plating or retrograde intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Functional scoring including SMFA, Bother Index, EQ Health and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs and number and type of adverse events. RESULTS. Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months post injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability & ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups. CONCLUSIONS: Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year following injury, but remain impaired one year post operatively. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence