What question did this study set out to answer?

The study aims to compare the functional outcomes and complications of locking compression plates and retrograde nails in treating distal femur fractures.

April 13, 2026Open Access

Comparing Locking Compression Plate and Retrograde Nail in the management of distal femur fracture: A Comprehensive Analysis

Key Points

The study aims to compare the functional outcomes and complications of locking compression plates and retrograde nails in treating distal femur fractures.
Conducted a prospective comparative study from August 2022 to August 2024.
Included 46 skeletally mature patients with distal femur fractures treated with either LCP or RN.
Utilized the Hospital for Special Surgery knee rating scale (HSS) to assess functional outcomes.
Compared intra-operative parameters and follow-up complications like non-union and knee stiffness.
The retrograde nail group showed significantly better knee flexion and early union.
Complications including non-union and infection were comparable between LCP and RN groups.
Blood loss was significantly higher in the LCP group, while radiation exposure was more in the RN group.
Mean HSS scores were similar, with LCP at 77.32 and RN at 84.16, indicating no significant difference.

Abstract

Introduction: Distal femur fractures due to their complex characteristics can give nightmares to trauma surgeons. Goal of treatment is to restore normal anatomy, achieve bone union and restore early joint movement. Both retrograde nail (RN) and locking compression plate (LCP) are used for internal fixation. However, superiority of one over other is debatable. Aims and Objectives: The aim of the study was to compare functional outcome, intra-operative parameters and complications of LCP and RN. Materials and Methods: This was a prospective comparative study conducted between August 2022 and August 2024. 46 skeletally mature patients of distal femur fracture were included in the study, out of which 23 were treated with LCP and 23 with RN. Fractures classified as AO Type A2, A3, and C1 fractures were included in the study. Hospital for special surgery knee rating scale (HSS) was used for functional outcome. Complications such as non-union, infection, anterior knee pain and knee stiffness were compared between two groups during follow-up. Results: Blood loss was significantly more in plating group, whereas radiation exposure was significantly more in nailing group. The patients were followed-up for a duration of 18 months. Knee flexion was significantly more in RN group. Early union was seen in nailing, with more cases of anterior knee pain, whereas more flexion deformity and extensor lag were observed in the LCP group. One case of each non-union and infection was seen in RN group. However, these parameters were comparable (P > 0.05). Mean HSS score at final follow-up was 77.32 ± 16.70 in the LCP group and 84.16 ± 10.23 in RN group, with no significant difference. Conclusion: Retrograde nailing comes out with better outcomes in terms of early union, less intra-operative blood loss and less post-operative complications. However, a larger study may still be needed for the results to be accepted into standard practice. Keywords: Distal femur fracture, locking compression plate, retrograde nail, union.

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