Retrograde Intramedullary Nailing Versus Plating for Distal Femur Fractures: A Prospective Comparative Study

Background: Distal femur fractures are technically demanding injuries because they occur near the knee, are often associated with high-energy trauma in younger adults, and require stable fixation that permits early mobilization.

Objectives: To compare operative characteristics, time to union, postoperative complications, and functional outcomes between retrograde intramedullary nailing and plating in adult distal femur fractures.

Methods: This hospital-based prospective comparative study was conducted in the Department of Orthopaedics, Maharajah's Institute of Medical Sciences, over 18 months. Sixty adults with distal femur fractures were treated with either retrograde intramedullary nailing or plate fixation, with 30 patients in each group. Demographic details, fracture subtype, operative duration, time to union, complications, and knee function were recorded. Functional outcome was assessed using the Lysholm and Gillquist knee scoring scale.

Results: Patients were predominantly aged 31-40 years, male, and injured in road traffic accidents. Müller A1 fractures were the most common subtype. Mean operative time was shorter with retrograde nailing than with plating (82.5 vs 107.5 minutes). Mean time to union was also lower in the retrograde nailing group (13.07 ± 2.91 vs 14.93 ± 2.49 weeks). Infection and knee pain/restricted range of motion occurred only in the plating group. Excellent functional outcome was achieved in 60.0% of the retrograde nailing group and 53.33% of the plating group, with no statistically significant difference in overall functional outcome.

Conclusion: Retrograde intramedullary nailing demonstrated shorter operative time and earlier fracture union, while both techniques provided broadly comparable complication profiles and functional recovery. Retrograde nailing appears to be an effective option for extra-articular distal femur fractures when fracture configuration permits its use.