Distal Dilemma: Antegrade or Retrograde Nailing in Distal Femur Shaft Fractures.

BACKGROUND

Distal femur fractures, though uncommon, present treatment challenges due to patient variability and fracture complexity. Various fixation methods exist, but there is no consensus on the optimal approach. This study compares clinical and functional outcomes of antegrade versus retrograde intramedullary nailing in distal femur fractures.

MATERIALS AND

METHODS

A prospective observational study of 60 patients with extra-articular distal femur fractures was conducted. Patients were alternately assigned to antegrade (n = 30) or retrograde (n = 30) nailing groups. Outcomes assessed included operative time, radiological union, knee range of motion (ROM), weight-bearing milestones, complications, and functional outcomes using Neer's scoring system. Statistical analysis compared results between groups.

RESULTS

Retrograde nailing showed significantly shorter operative times (85 ± 2.15 min vs. 95 ± 1.39 min), faster radiological union (10 ± 0.38 weeks vs. 14 ± 0.44 weeks), earlier partial (9.27 ± 0.37 weeks vs. 10.9 ± 0.49 weeks), and full weight bearing (15 ± 0.47 weeks vs. 18.2 ± 0.67 weeks) and slightly better knee ROM (117.3° ± 2° vs. 114.4° ± 1.8°) compared to antegrade nailing (P < 0.05). Functional outcomes were superior in the retrograde group, with 67.7% excellent scores versus 26.7% in the antegrade group. Retrograde nailing had more cases of anterior knee pain, while antegrade nailing was associated with higher rates of hip pain, infections, and delayed union.

CONCLUSION

Retrograde intramedullary nailing offers advantages in surgical efficiency, fracture healing, and early mobilization, making it a reliable option for managing distal femur fractures. However, attention to anterior knee pain is warranted. Further large-scale studies are recommended to confirm long-term outcomes.