Vol. 11, Issue 2 (2025)

Background: Extra-articular distal femur fractures (AO/OTA 33-A) are complex injuries that often result from high-energy trauma in younger individuals or low-energy falls in osteoporotic elderly patients. Surgical stabilization is essential for restoring limb alignment, facilitating early mobilization, and minimizing complications such as joint stiffness and malunion. Locking compression plates (LCP) and retrograde intramedullary nails (RIMN) are two widely accepted fixation strategies, each with distinct biomechanical and clinical implications. This study evaluates and compares the clinical efficacy, radiological union rates, and complication profiles of these two fixation methods.

Materials and Methods: A retrospective analysis was conducted on 50 skeletally mature patients treated surgically for extra-articular distal femur fractures at Civil Hospital, Ahmedabad, between January 2023 and January 2024. Patients were categorized into two cohorts based on the fixation method used: 25 underwent LCP fixation, and 25 received RIMN. Preoperative, intraoperative, and postoperative protocols were standardized. Functional outcomes were assessed using Neer’s score, while radiographic union was evaluated via serial imaging. Complications such as infection, implant failure, and malalignment were documented.

Results: The RIMN group showed a statistically significant reduction in mean time to radiographic union and earlier achievement of full weight-bearing. However, in cases with metaphyseal comminution or poor distal bone stock, LCP provided superior mechanical stability. Complication rates were comparable between groups, though the LCP group had slightly higher rates of superficial infection and implant-related irritation.

Conclusion: Both LCP and RIMN are effective for managing extra-articular distal femur fractures. RIMN offers advantages in union time and early rehabilitation, whereas LCP demonstrates superior performance in comminuted or osteoporotic distal femur anatomy. Patient-specific and fracture-specific considerations should guide implant selection.