Functional outcome in patients with extra-articular distal femur treated with retrograde intramedullary nailing versus minimally invasive plate osteosynthesis- A cross-sectional study

Introduction- Treatment of extra-articular distal femur fractures remains challenging. The present study aimed to compare the functional outcome of these fractures treated by retrograde nailing versus minimally invasive plate osteosynthesis. Method- This randomized trial was conducted between March 2018 and Feb 2020 at a tertiary care trauma center in Navi-Mumbai on 71 consecutive patients with extra-articular distal femur fractures. The inclusion criteria were closed extra-articular distal femur fractures occurring in adults. Floating knee injuries, ipsilateral lower limb fractures, pathological fractures, compound, and fractures with neurovascular injuries were excluded from the study. Thirty-seven patients in group A were treated with intramedullary nailing while Thirty-four patients in group B were treated by minimally invasive plate osteosynthesis. All the patients were followed up at 3,6,12 and 24 months respectively. Results- The mean age of the patients was 58.41 ± 4.21and 56.72 ± 8.13 in groups A and B respectively. The most common mechanism of injury was road traffic accidents with 42 (59.15%) cases. The most common fracture type was 33A2. The mean operative duration was 112.34 ± 13.8 minutes in group A and 98.28 ± 9.76 minutes in group B respectively which was statistically significant (p<0.0044). There were 3 (8.1%) cases in group A and 1 (2.9%) cases in group B who had superficial infection. There were 2 (5.4%) cases in group A and 4 (11.7%) cases in group B who had post-op knee stiffness. As per the Schatzker and Lambert criteria, 58 (81.6%) of the cases had excellent and good results. Conclusion- Although intramedullary nailing is associated with shorter operative time, the final results of both nailing and plate osteosynthesis are similar with no implant superior to another. Both the techniques have similar complication rates