Comparison of locking compression plating vs retrograde intramedullary nailing in distal femur extra-articular fractures

Background: The purpose of the study was to compare the outcome of distal femur extra articular fractures treated with locking plate and retrograde intramedullary nail.Methods: 86 patients’ distal femur extra-articular fractures were included in the study. 44 patients were operated with intramedullary nailing; 42 patients were operated with locking plate. Results of the 2 groups were compared with regards to clinical and radiological outcome, intraoperative timing and blood loss. Post-operative status of the patients was evaluated using the visual analogue scale, neer score, knee range of motion and radiological union on plain radiographs. Patients were followed-up at 4 weekly intervals from 8 to 28 weeks and then at 1 year.Results: Mean operative time and blood loss was less in intramedullary nailing group whereas intraoperative blood loss was less in the plating group. 6 patients developed surgical site infection in the plating group. Mean-time till radiological union was significantly better in intramedullary nailing group. 7 patients in plating group had issues with union (5 non-union, 2 delayed union) whereas 1 patient in IMN group had nonunion. 93% of intramedullary nailing cases were able to bear full weight at 12 weeks compared to 66% cases in plate group. Knee pain at 6 months was more in intramedullary nailing group.Conclusions: IMN proved to be a better modality of fixation of distal femur fracture fixation in our study in terms of operative time, union rates, infection rates and overall patient outcome if done with proper principles and techniques of intramedullary fixation