Nail Alone Results in Similar Clinical Outcomes With Less Perioperative Morbidity Compared With Nail Plate Combination in Treatment of Native Distal Femur Fractures.

OBJECTIVES

To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN + plate constructs for native distal femur fractures.

DESIGN

Retrospective review of operative distal femur fractures, 2018-2022.

SETTING

Urban level 1 trauma center.

PATIENT SELECTION CRITERIA: Included were patients >18 years old with AO/OTA 33A or 33C distal femur fractures and ≥6 months follow-up.

OUTCOME MEASURES AND COMPARISONS: Demog r aphics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), reoperations, complications, and return to weightbearing were collected and compared between the 3 fixation constructs.

RESULTS

One hundred thirty-seven patients were included (71 rIMN, 27 plate, 39 rIMN + plate). Median age was older for rIMN + plate than for rIMN (61 vs. 54 years, P = 0.015) and similar between rIMN + plate and plate groups (61 years for both, P = 0.68). There were no other differences in demographics among groups ( P > 0.05). The rIMN + plate group had longer operative time (256 minutes) and higher EBL (250cc) than rIMN alone (150 minutes, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared with plate alone (168 minutes, P = 0.071 and 250cc, P = 0.73) There were no differences in final coronal or sagittal alignment ( P = 0.78, P = 0.87, respectively) or reoperation rates ( P = 0.74) among groups. The rIMN + plate group showed a higher rate of radiographic union (66.7%) than the rIMN (42.3%) and plate (44.4%) groups ( P = 0.042). When controlling for patient age, time to weightbearing was similar among the groups ( P = 0.79).

CONCLUSIONS

Although the rIMN + plate combination led to higher rates of union, it did not decrease time to weightbearing or reoperation rates compared with rIMN alone, and was associated with longer operative time and greater blood loss.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.