Functional Outcome of Retrograde Femur Nail and DFLCP in Extra Articular Distal Femur Fracture

Muhammad Junaid; Muahmmad Nadeem Chaudhry; Muhammad Rehan Saleem; Abdul Aziz; Muhammad Haseeb; Kashif Ali Naz

doi:10.70749/ijbr.v3i6.2019

Authors

Muhammad Junaid Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan
Muahmmad Nadeem Chaudhry Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan
Muhammad Rehan Saleem Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan
Abdul Aziz Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan
Muhammad Haseeb Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan
Kashif Ali Naz Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan

DOI:

https://doi.org/10.70749/ijbr.v3i6.2019

Keywords:

Distal femur fracture, retrograde nailing, DFLCP, functional outcome, Knee Society Score, orthopedic trauma, Pakistan

Abstract

Introduction: Extra-articular fractures of the distal part of the femur are multiple-complication injuries that need to have a stable verification to recover well. The two surgical procedures undertaken regularly are retrograde intramedullary nailing and DFLCP. Selecting the correct method can significantly impact the functional outcomes, especially in environments with limited resources, such as Pakistan. Objective: To compare the functional result of retrograde femur nail with distal femur locking compression plate (DFLCP) in cases of extra-articular distal femur fractures at Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan. Materials and Methods: The study was a prospective comparative investigation conducted at Department of Orthopedics, Combined Military Hospital Rawalpindi, Pakistan in the duration from August, 2024 to January, 2025, involving 40 patients with extra-articular fractures of the distal femur. Patients were categorised into two groups: Group A, patients who received retrograde femoral nailing, and Group B, patients who underwent audibility CLCP. The outcome was measured in terms of functional status, as assessed by the Knee Society Score (KSS), and range of motion at 6 and 12 weeks. Result: Group A(nailing) had significant improvement on KSS at 12-week time points (82.5 vs. 76.9, p = 0.02). In Group A (110.2°), the knee flexion was higher than in Group B (102.4 °). The rate of complications is lower in the nailing group, with fewer cases of delayed union and malalignment. Conclusion: Retrograde femoral nailing was found to have better short-term functional outcomes and fewer complications than DFLCP in the treatment of extra-articular DFFs. The treatment must be personalised in terms of patient and fracture-specific differences.

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References

1. Shah MR, Dave SV, Dahiya A, Shah RR, Nagar S, Patel KR, SHAH MR. Surgical and Functional Outcomes of Distal Femur Fractures Operated With Distal Femur Locking Compression Plate Versus Intramedullary Supracondylar Nail. Cureus. 2025 Apr 27;17(4).

https://doi.org/10.7759/cureus.83062

2. Gupta G, Sah RK, Thakur P, Ruhullaha M, Thapa S. Functional Outcome of Locking Compression Plate in Distal Femur Fractures. Journal of National Medical College. 2023 Dec 31;8(2):7-13.

https://doi.org/10.3126/medphoenix.v8i2.61825

3. Madhu G, Varghese R, Samuel S. Functional Outcome Of Retrograde Intramedullary Nailing Versus Locked Compression Plating In The Treatment Of Supracondylar Fracture Femur. Int J Acad Med Pharm. 2024;6(3):1016-24.

4. Mulimani MB, Katti S, Sankal NB, Malipatil SS, Herakal Y. A Study of Functional Outcome in Distal Femur Fracture in Adults Treated with Locking Compression Plate A Case Series. Res. J. Med. Sci. 2024 Apr 4;18:19-22.

5. Pahadiya AK, Joshi N, Dhukia R, Shekhawat V, Singh D. Comparative study of distal femoral locking compression plate and tens nail versus lateral distal femur plate in management of distal femur fracture cases. International Journal of Orthopaedics. 2021;7(2):327-31.

https://doi.org/10.22271/ortho.2021.v7.i2e.2647

6. Trikha V, Gupta A. Implantology of Fractures of the Distal Femur. InHandbook of Orthopaedic Trauma Implantology 2023 Jul 19 (pp. 1-24). Singapore: Springer Nature Singapore.

https://doi.org/10.22271/ortho.2021.v7.i2e.2647

7. Gönder N, Özel V, Kaya O, Demir İH. Comparison of retrograde intramedullary nailing, antegrade intramedullary nailing and distal femur locked plating methods in the treatment of extra-articular distal femur fractures: A retrospective analysis: Treatment of extraarticular distal femur fractures. The Injector. 2023 Oct 24;2(3):253-60.

8. Patil NV, Arun GR, Deepak MK, Jyothishlal MK. Correlation between the functional and radiological outcome of distal femur fractures treated with minimally invasive percutaneous plate osteosynthesis locking compression plate, Nat. J. Clin. Orthopaed. 2022;6.

https://doi.org/10.33545/orthor.2022.v6.i1a.343

9. Shawky M, Karim MA, Farahat AS, El-Hamalawy AG. Management of distal femoral fractures: A review article. Journal of Clinical Orthopaedics and Trauma. 2023 Nov 30;46:102291.

https://doi.org/10.1016/j.jcot.2023.102291

10. Rodham PL, Giannoudis V, Tornetta III P, Giannoudis PV. Epidemiology of Fracture Fixation Failure. InFailed Fracture Fixation: Revision Surgery Made Easy 2024 Jan 31 (pp. 1-21). Cham: Springer International Publishing.

https://doi.org/10.1007/978-3-031-39692-2_1

11. Breyer G, Usmani K, Hwang R, Begley B, Mashru RP, Gutowski CJ. Knee pain and functional outcomes after retrograde femoral nailing: a retrospective review. Archives of Bone and Joint Surgery. 2023;11(3):218.

12. El-Seedy AI, Zaki EM, El-Sheikh IF, Sakr SA. Long-term functional outcome of knee after antegrade versus retrograde intramedullary nailing for femoral fracture. Menoufia Medical Journal. 2022;35(2):899-904.

https://doi.org/10.4103/mmj.mmj_240_21

13. Kim HS, Yoon YC, Lee SJ, Sim JA. Which fixation produces the best outcome for distal femoral fractures? Meta-analysis and systematic review of retrograde nailing versus distal femoral plating in 2432 patients and 33 studies. European Journal of Trauma and Emergency Surgery. 2024 Jun;50(3):763-80.

https://doi.org/10.1007/s00068-023-02393-8

14. Kishore R, Alam M, Thahseen N, Cm B, Vellingiri K, Rajendran Sr RK. Retrograde Intramedullary Nailing for Distal Femur Fractures: A Prospective Study of Functional Outcomes, Complications, and Union Rates. Cureus. 2025 Apr 12;17(4).

https://doi.org/10.7759/cureus.82139

15. AHMED U, AHMAD U, ZAHEER M, SADAQAT A, KHALID Z. Comparison of outcome with retrograde nailing versus locked compressive plating in the treatment of extra articular supracondylar femur fractures. Methodology. 2021 Nov;15:3410-2.

https://doi.org/10.53350/pjmhs2115123410

16. Manjeswar MP, Kale A, Raithatha H, Shah S. Study of clinical results and functional outcome of patients with distal femur fracture treated with dual plating. Cureus. 2023 Jan 25;15(1).

https://doi.org/10.7759/cureus.34182

17. Tripathy SK, Mishra NP, Varghese P, Panigrahi S, Purudappa PP, Goel A, Sen RK. Dual-plating in distal femur fracture: a systematic review and limited meta-analysis. Indian Journal of Orthopaedics. 2022 Feb;56(2):183-207.

https://doi.org/10.1007/s43465-021-00489-0

18. Singh R, Ambade R, Landge S, Goyal S, Goel S. Comprehensive review on distal femur fractures: from epidemiology to treatment strategies. Cureus. 2024 Apr 9;16(4).

https://doi.org/10.7759/cureus.57937