Functional Outcome of Retrograde Femoral Nailing Versus Minimally Invasive Percutaneous Plate Osteosynthesis in Extra-Articular Distal Femur Fractures: A Prospective Quasi-Randomized Comparative Study

Abstract

Abstract Introduction: Distal femur fractures represent a challenging injury due to their proximity to the knee joint and the need to restore limb alignment and function. Surgical management has evolved with techniques such as retrograde femoral nailing (RFN) and minimally invasive percutaneous plate osteosynthesis (MIPPO). Both techniques aim to achieve stable fixation while preserving soft tissue and vascularity. We performed an analysis on both groups (30 patients each), and our primary objectives compared were radiological union time, weight-bearing, and functional outcome using NEER’s score. Our secondary objectives were complications, surgical time, and fluoroscopy exposure. Materials and Methods: This prospective comparative study included 60 patients with extra-articular distal femur fractures treated at a tertiary care center. Patients were divided into two groups using an alternate allocation method: (1) Group A: RFN (n = 30). (2) Group B: MIPPO with locking plate (n = 30). Results: Patients treated with RFN demonstrated earlier initiation of partial and full weight-bearing and earlier fracture union compared with the MIPPO group. Functional outcomes assessed by NEER’s score were better in the RFN group at 6 weeks and 3 months, while both groups showed comparable results by 6 months follow-up. Complications observed included superficial infection, knee stiffness, malunion, and non-union. Conclusion: Both RFN and MIPPO are effective methods for treating extra-articular distal femur fractures. RFN allows earlier mobilization and functional recovery, while MIPPO preserves fracture biology and soft-tissue integrity. The choice of technique should be individualized based on fracture pattern, patient factors, and surgeon experience. Larger multicenter trials with longer follow-up are needed to confirm these findings.