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Randomized Controlled Trial
. 2023 Feb 1;37(2):70-76.
doi: 10.1097/BOT.0000000000002482.

Locked Lateral Plating Versus Retrograde Nailing for Distal Femur Fractures: A Multicenter Randomized Trial

Robert P Dunbar  1 , Kenneth A Egol  2 , Clifford B Jones  3 , Jan P Ertl  4 , Brian Mullis  4 , Edward Perez  5 , Cory A Collinge  6 , Robert Ostrum  7 , Catherine Humphrey  8 , Michael J Gardner  9 , William M Ricci  10 , Laura S Phieffer  11 , David Teague  12 , William Ertl  12 , Christopher T Born  13 , Alan Zonno  13 , Jodi Siegel  7 , Henry Claude Sagi  14 , Andrew Pollak  15 , Andrew H Schmidt  16 , David C Templeman  16 , Andrew Sems  17 , Darin M Friess  18 , Hans-Christoph Pape  19 , James C Krieg  20 , Paul Tornetta 3rd  21
Affiliations
Randomized Controlled Trial

Locked Lateral Plating Versus Retrograde Nailing for Distal Femur Fractures: A Multicenter Randomized Trial

Robert P Dunbar et al. J Orthop Trauma. .

Abstract

Objectives: The 2 main forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment.

Design: Multicenter randomized controlled trial.

Setting: Twenty academic trauma centers.

Patients/participants: One hundred sixty patients with distal femur fractures were enrolled. One hundred twenty-six patients were followed 12 months. Patients were randomized to plating in 62 cases and intramedullary nailing in 64 cases.

Intervention: Lateral locked plating or retrograde intramedullary nailing.

Main outcome measurements: Functional scoring including Short Musculoskeletal Functional Assessment, bother index, EQ Health, and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs, and number and type of adverse events.

Results: Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months after injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability, and ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups.

Conclusions: Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year after injury but remain impaired 1 year postoperatively.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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References

    1. Streubel PN, Ricci WM, Wong A, et al. Mortality after distal femur fractures in elderly patients. J Orthop Trauma. 2011; 469:1188–1196.
    1. Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28:83–89.
    1. Rodriguez EK, Zurakowski D, Herder L, et al. Mechanical construct characteristics predisposing to nonunion after locked lateral plating of distal femur fractures. J Orthop Trauma. 2016;30:403–408.
    1. Hoffmann MF, Jones CB, Sietsema DL, et al. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res. 2013;8:43.
    1. Butt MS, Krikler SJ, Ali MS. Displaced fractures of the distal femur in elderly patients. Operative versus non operative treatment. J Bone Joint Surg Br. 1996;78:110–114.

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