Comparative study of operative treatment of distal femur fractures using retrograde intramedullary nail versus locking plate; Retrospective study

Abstract

Introduction: The overall incidence of distal femur fractures is approximately 37 per 100,000 person-years.1 These fractures are either caused by high energy trauma in younger group or low energy falls in elderly population typically older women. As these fractures can lead to long term disability managing them is challenging task. Operative treatment for fracture fixation is recommended for optimal outcome. Although different modes of fracture fixation has evolved and no single method is uniformly successful. In our study we have compared fixation of distal femur fracture using locking plate and intramedullary nail. Materials and Methods: Retrospectively collected data of operated distal femur fracture of 60 patients was included. Out of these 30 patients were operated with retrograde distal femoral nail and 30 were operated with locking distal femur plate. Patients were assessed with plain radiographs and CT scan was done for complex and intra articular fractures. AO ( Muller) classification was used to classify the fracture type. Postoperative functional results were evaluated using Schatzker and Lambert critera at 1 year follow up. Results: Mean age of the patients in the study was 45 yrs. with 73.33 % male and 26.67 % female patients. There were 41 extra articular fractures (type A) while 19 were intrarticular fractures (type C). 22 type A and 8 type C fractures were treated with retrograde nailing while 19 type A fractures and 11 type C fractures were treated with locking plate. In LCP group 28.57% cases had excellent result while 42.86% cases had good result while in retrograde supracondylar nail 13.33% had excellent result and 23.33 % had good result. There were 2 cases of infection, one in each group and 3 cases of malunion, which were managed with nail. Delayed union was encountered in 3 patients, two of them were managed with LCP. Conclusion: Open reduction and internal fixation of distal femur has achieved excellent to good functional results with locking plate construct in all types of fractures while retrograde supracondylar nail can achieve comparable results when used in simple extraarticular fractures.For other fractures it is difficult to maintain length, alignment and rotation with retrograde nail. Keywords: distal femur fracture, Retrograde intramedullary nail, locking distal femur plate, minimally invasive plating technique, Schatzker and Lambert criteria