Abstract Background: Distal femur fractures are difficult to manage due to their proximity to the knee joint and complex anatomy. Locked distal femur plating and retrograde intramedullary nailing are two established fixation methods, each offering specific benefits. However, consistent evidence favoring one technique over the other is still limited. Aim: To compare the functional and radiological outcomes of locked distal femur plating and retrograde intramedullary nailing (N) in adult distal femur fractures. Materials and Methods: This prospective observational study was conducted between June 2023 and December 2024, including 40 adult patients with distal femur fractures. Patients were divided into two groups: locking plate (LP) ( n = 20) and N ( n = 20), based on surgeon preference. Standardized surgical techniques, postoperative care, and rehabilitation protocols were followed. Functional outcomes were assessed using knee flexion and the Hospital for Special Surgery (HSS) knee score, whereas radiological union was defined by bridging of three cortices. Results: Both groups had similar baseline characteristics. LP showed a shorter operative time (88.4 ± 17.6 min) but higher blood loss (323 ± 74 mL). Nailing achieved better final knee flexion (126.7° ± 11.6°) and slightly higher HSS scores, though not statistically significant. Union rates were comparable between the two groups, with an average time to union of around 24 weeks. Conclusion: Both fixation methods provided reliable union and satisfactory functional recovery. Retrograde nailing resulted in greater knee mobility, while plating offered reduced operative time. Implant selection should depend on fracture pattern and patient considerations.
Tonk et al. (Thu,) studied this question.