1Senior Resident, Krishna Vishwa Vidyapeeth, Karad, India
Background: Distal femur fractures (DFFs) are associated with significant morbidity, especially in bone of the distal femur, which is osteoporotic and where fixation groups are comminuted, high case fixation failure rates, delayed union, and reoperation have been observed historically. It is proposed that construct biomechanics and early mobilization are important outcome determinants and combined fixation strategies (nail plate constructs) can enhance stability relative to single-implant constructs.
Methods: We conducted a retrospective cohort study at a tertiary trauma unit with surgically treated adults with OTA/AO 33A and 33C fractures of the distal femur between January 2020 and December 2024. Patients took either (1) retrograde intramedullary nailing with supplemental minimally invasive lateral locking plate (RFN+SP) or (2) isolated lateral distal femur locking plate fixation (LP). Radiographic being united by 24 weeks, was primary outcome. Secondary outcomes were time to union, implant failure, reoperation to encourage union, deep infection, malalignment and functional recovery (Lower Extremity Functional Scale; LEFS). Multivariate regression that was controlled by age, type of fracture, open fracture, diabetes, smoking and medial comminution.
Results: They were analyzed on 124 patients (RFN+SP, n=58: LP, n=66), the mean age of the population was 56.8 ± 18.9 years. By 24 weeks, union with RFN + SP 82.8 vs. LP (adjusted OR 2.41, 95% interval 1.08-5.38). RFN+SP (19.1 ± 6.2 weeks to use union) had shorter times of time to union compared to LP (22.4 ± 7.5 weeks to use union; p=0.01). There was 5.2 vs. 15.2 (p=0.048) implant failure and 8.6 vs. 18.2 (p=0.09) redefinition to facilitate union. In RFN+SP LEFS was larger than LP respectively at 6 months (55.6 compared to 49.2; p=0.02).
Conclusion: Similar to the case of isolated locking plate fixation, retrograde nailing along with supplemental lateral plating offered better early union rates, reduced time to union and reduced construct failure. These results confirm the use of combined fixation as a stability-promoting measure in the chosen distal femur fractures in which early weight bearing takes priority.
Keywords: distal femur fracture; retrograde intramedullary nail; locking plate; nail–plate construct; union; implant failure.
How to cite this article: Deshmukh V. Retrograde Femoral Nailing with Supplemental Lateral Plating Versus Isolated Locking Plate Fixation for Distal Femur Fractures: A Retrospective Comparative Cohort Study. Int J Drug Deliv Technol. 2026;16(9s): 22-27; DOI: 10.25258/ijddt.16.9s.3
Source of support: None
Conflict of interest: None