OTSR - 2026-03-20 - Journal Article
Comparative evaluation of antegrade nailing, retrograde nailing, and locking plate osteosynthesis in the management of extra-articular distal femur fractures in patients under 60 years.
Polat Ö, Çepni SK, Dünki A, Çamur S, Batıbay SG
Topics
Key Takeaway
At mean 70.8-month follow-up, retrograde nailing produced significantly worse EQ-5D quality-of-life scores (p=0.001) and lower Lysholm functional scores (p=0.030) compared to antegrade nailing and locking plate fixation for extra-articular distal femur fractures in patients under 60.
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Summary
This retrospective case-control study compared antegrade nailing, retrograde nailing, and locking plate fixation for extra-articular distal femur fractures in patients under 60 years treated between 2015-2022. Knee flexion differed significantly among groups at final follow-up (p=0.007), and Lysholm scores showed intergroup differences at both 1 year and final follow-up (p=0.030). EQ-5D scores were equivalent at 1 year but diverged by final follow-up, with the retrograde nailing group scoring significantly worse (p=0.001).
Key Limitation
Retrospective non-randomized allocation means fracture complexity, bone quality, and surgeon selection bias are uncontrolled, making it impossible to determine whether inferior retrograde nailing outcomes reflect the technique itself or the case mix directed toward it.
Original Abstract
BACKGROUND
Extra-articular distal femoral fractures typically occur in younger adults following high-energy trauma and are commonly treated with antegrade nailing, retrograde nailing, or plate fixation. In this study, we asked three key questions: Do these surgical methods result in different clinical and functional outcomes in patients under 60 years? If differences exist, do they persist at mid-term follow-up? How does each technique influence patients' quality of life?
PATIENTS AND METHODS
To address this question, we conducted a retrospective case-control study of 117 patients treated between January 2015 and December 2022. Patients were allocated to three groups: AIMN (n = 38), RIMN (n = 39), and locking plate fixation (n = 40). Demographic and clinical data were analyzed, and functional and quality-of-life outcomes were assessed using the Lysholm and EQ-5D scales.
RESULTS
The mean follow-up was 70.76 ± 30.54 months (median: 76; range: 24-119). Knee flexion at final follow-up differed significantly among groups (p = 0.007). Functional outcomes measured by the Lysholm score also showed significant intergroup differences at both the first postoperative year and final follow-up (p = 0.030). Quality of life, assessed using the EQ-5D scale, showed no group differences at one year (p > 0.05). However, at final follow-up, the RIMN group had significantly poorer scores (p = 0.001).
DISCUSSION
In conclusion, all three surgical methods appeared to offer acceptable management options for extra-articular distal femur fractures in patients under 60 years of age. The comparatively lower functional and quality-of-life outcomes observed with retrograde nailing may point to certain limitations, though these findings should be interpreted with caution.
LEVEL OF EVIDENCE
III.