Randomized controlled trial to compare functional outcomes between Locking compression Plates and Retrograde Intramedullary Nails in distal femur fractures

Abstract

Objective: To evaluate the functional result at six months for adult patients with 33A2/3 distal femur fractures treated with locking compression plates (LCP) versus retrograde intramedullary nails (RIMN).

Methodology: A Randomized Controlled Trial was conducted in Department of Trauma & Orthopedics, Lady Reading Hospital Peshawar, from February 2022 to 2024. A total number of 96 patients, aged ≥ 18 years with close AO 33A2/3 distal femur fractures were randomized. Pathological fractures, periprosthetic fractures, patients with metabolic bone or prior knee arthritis or vascular damage requiring repair or underlying deformity in the affected limb precluding use of either implant or drug abuse or unfitness for anesthesia were excluded. The functional outcome was measured through Wilde modification of Neer knee score using Mann-Whitney U test for comparisons. RUST score was used to assess fracture healing. HRQoL was assessed using PROMIS-10.

Results: Out of 96 patients, 19 were female and 77 males. Mean age of the patients was 38.68±15.45 (18-78). Mann-Whitney U test was used for treatment comparison using Wilde modification of Neer knee score and the p value was 0.968. At 6 months, the healing rate was 82.5% in RIMN group and 71.79% in LCP group, according to RUST criteria. Mann-Whiney U test was used to compare physical and mental HRQoL scores between the groups and the p value was 0.028 and 0.122 respectively.

Conclusion: There was no significant difference in functional outcome using Wilde modification of Neer knee score.