Background: Distal femoral fractures constitute a significant proportion of all femoral fractures and are increasingly common due to the aging population and high-energy trauma in younger individuals. Surgical management is preferred for most cases, with the two predominant modalities being distal femoral locking plates (DFLP) and retrograde intramedullary nailing (RIMN). The choice between plating and nailing remains controversial, with ongoing debate regarding optimal treatment strategies based on fracture characteristics, patient factors, and surgeon preference. Objective: The primary objective of this study was to compare the time to radiographic fracture consolidation between patients treated with DFLP fixation and those treated with RIMN. Secondary objectives included comparison of functional outcomes at six months, as measured by the Knee Society Score (KSS), overall union rates, including delayed union and nonunion, and complication profiles, encompassing surgical site infection, implant failure, and postoperative malalignment. Methods: A retrospective cross-sectional study was conducted between November 1, 2023, and October 31, 2025, including 46 samples. The key outcome measures included operative time, union rate, time to union, functional scores (KSS), infection rate, malalignment, and implant failure. Results: Plating showed slightly higher nonunion and delayed union rates, especially in cases with poor soft tissue or comminution. Measured by KSS, both groups demonstrated comparable long-term functional outcomes. Plating had higher superficial infection rates due to wider exposure. RIMN showed higher malalignment, often valgus, due to technical limitations during reduction. Conclusion: There is no definitive superiority between distal femur plating and nailing. Both yield excellent outcomes when applied judiciously. DFLP is preferred in intra-articular, osteoporotic, and comminuted fractures. RIMN is ideal for simple, extra-articular fractures and for younger patients. Surgeon familiarity and patient-specific factors remain pivotal in decision-making.
Shravan et al. (Sat,) studied this question.
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