Comparison of retrograde intramedullary nailing, antegrade intramedullary nailing and distal femur locked plating methods in the treatment of extra-articular distal femur fractures: A retrospective analysis

Objective: Extra-articular distal femoral fractures account for 3% of femoral fractures, while they occur at a rate of 0.4% among all fractures. Although the basic treatment principles have not changed, the development of new implant designs for the biological fixation of this fracture is still ongoing. Among the treatment alternatives, internal fixation with anatomical plates and intramedullary nails are the most frequently utilized methods. Our objective in this research is to compare retrograde intramedullary nailing (RIMN), antegrade intramedullary nailing (AIMN) and distal femur locked plating (DFLP) methods in the treatment of extra-articular distal femoral fractures.Methods: The study retrospectively examined the data of 48 patients who underwent locked plating for extra-articular distal femoral fracture, 40 patients who underwent retrograde intramedullary nailing, and 36 patients who underwent antegrade intramedullary nailing between 2016 and 2021. Patients who had pathological fracture, periprosthetic fracture, ipsilateral tibial fracture and fracture-associated ligament and neurovascular injury and open fracture were excluded from the study. Fractures were classified based on the classification of Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopedic Trauma Association (AO/OTA) for distal femoral fractures. Functional findings were assessed with respect to the criteria determined by Sanders et al. and Lysholm knee score criteria.Results: The DFLP group included 48 patients (25 males and 23 females, aged 48.29±18.08 years), the RIMN group included 40 patients (19 males and 21 females, aged 49.93±18.31 years), and the AIMN group included 36 patients (15 males and 19 females, aged 46.22±18.6 years). There was no statistically significant difference between the groups in terms of age (p=0.727). The mean follow-up period was 26.04 months in the DFLP group, 25.9 months in the RIMN group, and 26.61 months in the AIMN group. The functional outcomes of the AIMN group were better than those of the other two groups based on the Sanders and Lysholm knee score criteria (p=0.001).Conclusion: The results of our current study revealed that all three methods yielded good results. Nevertheless, better functional outcomes were obtained in patients who underwent intramedullary fixation compared to the DFLP group. We suggest AIMN as a reliable method in the treatment of extra-articular distal femoral fractures due to preferable knee joint functions, low bleeding rate and low complication rates compared to other fixation methods.