Assessment of Functional and Radiological Outcomes of Multi-Lock Retrograde Nailing in Lower End of Femur.

Abstract

Fractures of the distal femur present significant challenges in orthopaedic trauma due to their complex anatomy, biomechanical demands, and potential complications such as malunion, non union, and stiffness. These fractures, though relatively rare (accounting for 6-7% of femur fractures), are associated with high morbidity, particularly in elderly osteoporotic patients and younger individuals with high-energy trauma. This study evaluates the role of multi lock retrograde intramedullary nailing-a minimally invasive fixation method-in the management of these fractures, focusing on functional and radiological outcomes. This prospective observational study included 60 patients (> 18 years) with AO classification types A1, A2, A3, C1, and C2 fractures treated at S.N. Medical College, Agra, between May 2023 and January 2025. All underwent multi lock retrograde nailing via a minimally invasive approach. Functional outcomes were assessed using the American Knee Society Score (AKSS) at 1, 3, and 6 months. Radiological outcomes were evaluated using standard anteroposterior and lateral X-rays. Secondary parameters included pain (VAS score), range of motion (ROM), complications, and time to full weight-bearing. At six months, most patients showed favourable recovery. Functional outcomes improved with 66.7% achieving good to excellent results, while only 10.0% had poor scores. Radiologically, 53.3% achieved complete union and just 3.3% showed no callus formation (<i>p</i> = 0.001). Range of motion of knee improved in 83.4% with > 90°, and pain reduced significantly, with 60.0% reporting minimal VAS scores (0-3) (<i>p</i> = 0.001). Complications were low (16.7%), mainly pain, stiffness, extensor lag, and one superficial infection, all managed conservatively. Full weight bearing was achieved in 93.3% within six months (<i>p</i> = 0.001). Multilock retrograde nailing is a safe and effective method for managing selected distal femur fractures, offering stable fixation, early mobilization, and favourable functional recovery with minimal complications.