Comparing Locking Compression Plate and Retrograde Nail in the management of distal femur fracture: A Comprehensive...

Distal femur fractures due to their complex characteristics can give nightmares to trauma surgeons. Goal of treatment is to restore normal anatomy, achieve bone union and restore early joint movement. Both retrograde nail (RN) and locking compression plate (LCP) are used for internal fixation. However, superiority of one over other is debatable.

The aim of the study was to compare functional outcome, intra-operative parameters and complications of LCP and RN.

This was a prospective comparative study conducted between August 2022 and August 2024. 46 skeletally mature patients of distal femur fracture were included in the study, out of which 23 were treated with LCP and 23 with RN. Fractures classified as AO Type A2, A3, and C1 fractures were included in the study. Hospital for special surgery knee rating scale (HSS) was used for functional outcome. Complications such as non-union, infection, anterior knee pain and knee stiffness were compared between two groups during follow-up.

Blood loss was significantly more in plating group, whereas radiation exposure was significantly more in nailing group. The patients were followed-up for a duration of 18 months. Knee flexion was significantly more in RN group. Early union was seen in nailing, with more cases of anterior knee pain, whereas more flexion deformity and extensor lag were observed in the LCP group. One case of each non-union and infection was seen in RN group. However, these parameters were comparable (P > 0.05). Mean HSS score at final follow-up was 77.32 ± 16.70 in the LCP group and 84.16 ± 10.23 in RN group, with no significant difference.

Retrograde nailing comes out with better outcomes in terms of early union, less intra-operative blood loss and less post-operative complications. However, a larger study may still be needed for the results to be accepted into standard practice.