Femoral Alignment Outcome of Distal Femoral Fracture Fixation with Retrograde Nailing versus Plating

Abstract

Background:Distal femoral fractures are serious injuries and represent a real challenge as regards their management. Treatment of such fractures has been controversial as various treatment modalities are available.The aim of this study was to compare the results of retrograde Nailing versus Plating technique in distal femoral fractures regarding alignment both radiologically and clinically.Patients and methods: we enrolled 18 patients with distal femoral fractures divided into two groups; Group a treated by RGN and group B treated by Plating technique. Clinical and radiological measurements of limb alignment, MAD,mLFDA, MPTA, pain, evidence of infection, deformities, and decrease of knee motion were performed to evaluate the outcomes after surgery in both techniques. Results:In group (A) there were six males and three females while in group (B) there were four males and five females. The age of the included patients in group (A) was with a mean of 32.55±8.14 while the mean of age in group (B) was with a mean of 36.44±8.42.The clinical measurements in normal limp was 4.66±1.32 in retrograde nail group while it was 4.88±1.58 in plating group, the MAD in fractured limp clinically was 5.38±1.89 in retrograde nail group while it was 6.48±2.31 in plating group.Medial Proximal Tibial Angle (MPTA) in normal limp radiologically was 88.00±2.12 in retrograde nail group while it was 87.11±2.97 in plating group (P=0.498), the MPTA in fractured limp radiologically was 87.77±1.85 in retrograde nail group while it was 87.88±3.48 in plating group (P =0.663) with no significant difference between groups and no significant between fracture and normal in both groups.In our study the complication including infection were in two patients in group (A) and four patients in group (B).Knee pain in six patients of group (A) and three patients in group (B).Reduction range of motion was found in three patients in group (A) and seven patients in group (B).While delayed of union was one patient in group (B). The only significant difference was found is reduction range of motion which is in group (B), while there were no significant difference regarding the other complications between the two groups. Conclusions:In our study, functional results trended toward better outcomes in distal femoral nails group than plates in terms of knee flexion, early weight bearing, but incidence of knee pain is higher in nailing group as compare to plating group. Therefore, Nailing technique is a better fixation system for distal femurfracture.