Comparison of Functional Outcome of Intra-Articular Distal Femur Fracture Management with Retrograde Nail with That of Locking Compression Plate - A Clinical Interventional Study

Author(s): Manoranjan Mallik1 , Satyajeet Ray2 , Abinash Ray3 , Debi Prasad Nanda4 , Dilip Kumar Chand5 , Amrit Kumar Panda6

BACKGROUND Intraarticular distal femur fracture has always been difficult to treat and the choice of fixation device often leads to confusion. Retrograde nailing with distal femur nail in a closed manner and open reduction and internal fixation with locking compression plate are the two most widely accepted methods of fixation. We wanted to compare the efficacy and functional outcome of these two methods. METHODS This is a prospective interventional study of 20 patients with closed intra-articular distal femoral fracture treated either with retrograde nailing or locking compression plate. They were divided into two groups of 10 patients each. In one group retrograde nailing was done while in the other group locking plate was used for fixation. The patients were followed up monthly for six months thereafter in 12 & 18 months. Every time, radiological signs of healing, range of movement of knee, onset of complications like knee pain, and infection were noted and functional assessment scoring was done as per Neer’s score. RESULTS The mean duration of surgery in nailing group was 68 ± 12.2 minutes while it was 81 ± 11.6 minutes in plating group which was statistically significant (p-value = 0.025). Average fracture union time was better in nailing (15.2 ± 1.2 weeks) than plating group (18 ± 1.4 weeks) as assessed both clinically & radiologically (p-value = 0.0001). The average knee flexion was better in nailing (104.8 ± 9.4) than plating (91.4 ± 8.9) (p-value = 0.0042). Post-operative Neer’s score was higher in nailing (86.2 ± 10.6) than the plating group (63.8 ± 9.4) which was statistically significant. CONCLUSIONS In our study, retrograde nailing with distal femoral nail was found to be a better fixation system for both extra- as well as intra-articular fractures (AO type C1 & C2) of distal femur with better outcome in terms of range of movements, mobilization, time to union, operative time and blood loss.