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

Abstract

To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN+plate constructs for native distal femur fractures. Retrospective review of operative distal femur fractures, 2018-2022. Urban level one trauma center. Included were patients >18 years-old with AO/OTA 33A or 33C distal femur fractures and >=6 months follow-up. Demographics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), re-operations, complications, and return to weightbearing. were collected and compared between the three fixation constructs. 137 patients were included (71 rIMN, 27 plate, 39 rIMN+plate). Median age was older for rIMN+plate compared to 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 min) and higher EBL (250cc) compared to rIMN alone (150 min, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared to plate alone (168 min, 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%) compared to the rIMN (42.3%) and plate (44.4%) groups (P=0.042) . When controlling for patient age, time to weight bearing was similar among the groups (P =0.79). While the rIMN+plate combination led to higher rates of union, it did not decrease time to weightbearing or re-operation rates compared to rIMN alone, and was associated with longer operative time and greater blood loss. Level III.