Management of Distal Femur Fractures in Adults: An Overview of Options.

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Abstract

[Indexed for MEDLINE] 17. J Am Acad Orthop Surg. 2026 May 15;34(10):e1442-e1449. doi: 10.5435/JAAOS-D-25-00575. Epub 2025 Nov 18. Nail Versus Plate for Distal Femur Fracture: A Propensity-matched Analysis. Brodke D(1), Zukotynski BK, Devana S, Hernandez A, O'Hara N, Burke C, Gupta J, McKibben N, O'Toole R, Morellato J, Gillon H, Walters M, Barber C, Perdue P, Dekeyser G, Steffenson L, Marchand L, Fairres MJ, Black L, Working Z, Roddy E, El Naga A, Hogue M, Gulbrandsen T, Atassi O, Mitchell T, Shymon S, Lee C. Author information: (1)From the Department of Orthopaedic Surgery, University of California, Los Angeles, CA (Zukotynski, Devana, Hernandez, and Lee), the Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center at the University of Maryland, Baltimore, MD (O'Hara, Burke, Gupta, McKibben, and O'Toole), Department of Orthopaedic Surgery, University of Mississippi, Oxford, MS (Morellato, Gillon, and Walters), Department of Orthopaedic Surgery, Virginia Commonwealth University (Barber and Perdue), Richmond, VA, University of Utah, Salt Lake City, UT (Steffenson, and Marchand), Department of Orthopaedic Surgery, Los Angeles County Harbor-UCLA Medical Center, West Carson, CA (Fairres and Shymon), Department of Orthopaedic Surgery, Oregon Health & Science University (Brodke, Dekeyser, Black, and Working), the Department of Orthopaedic Surgery, University of California, San Francisco, CA (Roddy and El Naga), the Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA (Hogue and Gulbrandsen) and the Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX (Atassi, and Mitchell). INTRODUCTION: Distal femur fractures are commonly treated with retrograde intramedullary nails or lateral locked plates. Although enthusiasm is growing for dual-implant constructs, most fractures are still treated with a single implant, though it remains unclear whether one implant type offers superior outcomes. This study compared revision surgery rates as well as clinical and radiographic outcomes between matched cohorts of distal femur fractures treated with intramedullary nails or lateral plates. METHODS: This multicenter retrospective study included adult patients with OTA/AO 33A or 33C distal femur fractures treated with isolated retrograde intramedullary nails or lateral locked plates with a minimum 3-month follow-up at 10 level-1 trauma centers. Outcomes were compared between propensity-matched nail and plate groups including all-cause revision surgery, unplanned revision surgery to promote union, revision surgery for deep surgical site infection, and modified Radiological Union Scale for Tibia scores. RESULTS: A total of 245 fractures treated with intramedullary nails were propensity score-matched 1:1 to 245 fractures treated with a single locked lateral plate. At a mean follow-up of 16 months, no significant differences were found in all-cause revision surgery (24% vs. 19%, P = 0.2), revision surgery to promote union (8.2% vs. 10%, P = 0.5), revision surgery for infection (5.7% vs. 5.7%, P > 0.9), or modified Radiological Union Scale for Tibia scores at 3 months (9 vs. 9, P = 0.6). No notable differences were observed in radiographic postoperative reduction parameters, surgical duration, follow-up duration, or qualitative clinical outcomes between the nail and plate groups. CONCLUSION: Distal femur fractures treated with retrograde intramedullary nails or lateral locked plates showed no notable differences in revision surgery rates, radiographic healing, or qualitative clinical outcomes. Surgeons should choose nails or plates based on experience, fracture type, and perceived ease of achieving a good reduction with the specific implant. LEVEL OF EVIDENCE: III. Copyright © 2025 by the American Academy of Orthopaedic Surgeons. DOI: 10.5435/JAAOS-D-25-00575