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Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Retrograde Intramedullary Nailing Versus Locking Plate Fixation in Extra-Articular Distal Femur Fractures: A
Shatrughan Singh Tomar1, Abhilekh Mishra1, Arunaditya Singh Thakur1
1Department of Orthopaedics, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India.
Introduction:
Distal femur fractures require stable fixation that permits restoration of alignment and early functional recovery. Retrograde intramedullary nailing distal femur nailing (DFN) and distal femoral locking plate fixation locking compression plate (LCP) are commonly used for extra-articular fractures, but their comparative functional and radiological outcomes remain debated.
Aim:
This study compared operative, functional, radiological, and complication outcomes of DFN and LCP in adult patients with extra-articular distal femur fractures.
Materials And Methods:
This prospective study was conducted at the Department of Orthopaedics, Gajra Raja Medical College, Gwalior, from November 2023 to March 2025. A total of 36 adults with AO/OTA type 33-A extra-articular distal femur fractures were included, with 18 patients treated with DFN and 18 with LCP. Patients with pathological fractures, Gustilo type III open fractures, intra-articular fractures, or incomplete consent were excluded. Operative parameters, functional outcomes, radiological outcomes, time to full weight bearing, and complications were assessed.
Results:
DFN was associated with significantly shorter operative time than LCP (75.67 ± 7.58 vs. 105.61 ± 10.51 min) and earlier full weight bearing (16.50 ± 3.75 vs. 26.19 ± 3.92 weeks). DFN also demonstrated significantly better knee flexion scores (17.78 ± 2.46 vs. 12.89 ± 4.01), work scores (10.00 ± 0.00 vs. 8.89 ± 1.97), roentgenogram scores (13.83 ± 2.33 vs. 11.67 ± 3.40), and total anatomical scores (28.50 ± 3.60 vs. 25.33 ± 5.37). Overall complication rates were identical (11.1% in each group; P = 1.000), whereas non-union was numerically less frequent with DFN (5.6% vs. 16.7%; P = 0.603).
Conclusion:
Retrograde intramedullary nailing was associated with shorter operative time, better knee flexion, improved work-related function, superior selected radiological outcomes, and substantially earlier full weight bearing than locking plate fixation. Although overall complication rates were comparable, the findings favor DFN for clinically suitable extra-articular AO/OTA 33-A distal femur fractures. Larger randomized studies are warranted to confirm these findings.
