Comparison of the functional and radiological outcomes of isolated lateral plate fixation versus combined retrograde femoral nail with plate fixation in distal femur fractures

Abstract

Introduction: Distal femoral fractures are complex injuries involving the distal femur near the knee joint and are associated with significant morbidity due to disruption of knee biomechanics. This study aimed to compare functional and radiological outcomes of isolated lateral plate fixation versus combined retrograde femoral nail with plate fixation. Materials and Methods: A prospective comparative study of 30 patients with AO/OTA 33A distal femur fractures was conducted at Kanti Devi Medical College Hospital from April 2024 to September 2025. Patients were randomized into two groups treated with either lateral locking plate fixation or combined retrograde intramedullary nail with plate fixation and followed for six months. Outcome was assessed and compared. Results: Combined nail-plate fixation demonstrated earlier partial and full weight bearing and faster radiological union compared with isolated plate fixation. Functional scores (WOMAC and KSSS) and union rates were higher in the combined fixation group, with fewer complications and no cases of non-union. Conclusion: Combined retrograde nail with plate fixation provides improved mechanical stability, earlier mobilization, and better fracture healing outcomes. It may represent a more reliable fixation strategy than isolated lateral plating for distal femur fractures.