Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Abstract

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Keywords

• distal femur nail
• implant
• neurovascular bundle