JAAOS - 2026-05-15 - Journal Article; Multicenter Study; Comparative Study
Nail Versus Plate for Distal Femur Fracture: A Propensity-matched Analysis.
Brodke D, Zukotynski BK, Devana S, Hernandez A, O'Hara N, Burke C, Gupta J, McKibben N, O'Toole R, Morellato J, Gillon H, Walters M, Barber C, Perdue P, Dekeyser G, Steffenson L, Marchand L, Fairres MJ, Black L, Working Z, Roddy E, El Naga A, Hogue M, Gulbrandsen T, Atassi O, Mitchell T, Shymon S, Lee C
Topics
Key Takeaway
Retrograde nail versus lateral locked plate for distal femur fractures showed no significant difference in all-cause revision (24% vs. 19%, P=0.2) or union-promoting revision (8.2% vs. 10%, P=0.5) at mean 16-month follow-up in a propensity-matched cohort of 490 fractures.
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Summary
This multicenter retrospective study asked whether retrograde IM nail or lateral locked plate produces superior outcomes for OTA/AO 33A and 33C distal femur fractures. Propensity score matching was used across 10 Level-1 trauma centers to compare revision rates, infection, and modified RUST scores. No significant differences were found in any primary or secondary outcome, including infection-driven revision (5.7% vs. 5.7%) and 3-month modified RUST scores (9 vs. 9).
Key Limitation
Retrospective design with heterogeneous fracture patterns (33A and 33C pooled) and no patient-reported outcome measures prevents conclusions about functional recovery differences between implants.
Original Abstract
INTRODUCTION
Distal femur fractures are commonly treated with retrograde intramedullary nails or lateral locked plates. Although enthusiasm is growing for dual-implant constructs, most fractures are still treated with a single implant, though it remains unclear whether one implant type offers superior outcomes. This study compared revision surgery rates as well as clinical and radiographic outcomes between matched cohorts of distal femur fractures treated with intramedullary nails or lateral plates.
METHODS
This multicenter retrospective study included adult patients with OTA/AO 33A or 33C distal femur fractures treated with isolated retrograde intramedullary nails or lateral locked plates with a minimum 3-month follow-up at 10 level-1 trauma centers. Outcomes were compared between propensity-matched nail and plate groups including all-cause revision surgery, unplanned revision surgery to promote union, revision surgery for deep surgical site infection, and modified Radiological Union Scale for Tibia scores.
RESULTS
A total of 245 fractures treated with intramedullary nails were propensity score-matched 1:1 to 245 fractures treated with a single locked lateral plate. At a mean follow-up of 16 months, no significant differences were found in all-cause revision surgery (24% vs. 19%, P = 0.2), revision surgery to promote union (8.2% vs. 10%, P = 0.5), revision surgery for infection (5.7% vs. 5.7%, P > 0.9), or modified Radiological Union Scale for Tibia scores at 3 months (9 vs. 9, P = 0.6). No notable differences were observed in radiographic postoperative reduction parameters, surgical duration, follow-up duration, or qualitative clinical outcomes between the nail and plate groups.
CONCLUSION
Distal femur fractures treated with retrograde intramedullary nails or lateral locked plates showed no notable differences in revision surgery rates, radiographic healing, or qualitative clinical outcomes. Surgeons should choose nails or plates based on experience, fracture type, and perceived ease of achieving a good reduction with the specific implant.
LEVEL OF EVIDENCE
III.