SynthesisEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2024
Which fixation produces the best outcome for distal femoral fractures? Meta-analysis and systematic review of retrograde nailing versus distal femoral plating in 2432 patients and 33 studies.
Synthesis in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 12 citations in OpenAlex.
- [Extra-articular fracture of the distal femur : Characteristics and treatment principles].Unfallchirurgie (Heidelberg, Germany) · 2026Review
- Iatrogenic vascular injury during retrograde intramedullary nailing of a distal femur fracture: a case report.Journal of trauma and injury · 2025Article
- [Value of retrograde femoral nailing : Pros and cons].Unfallchirurgie (Heidelberg, Germany) · 2025Review
- Emerging Trends in Distal Femur Fracture Treatment Modalities - A Narrative Review.Journal of orthopaedic case reports · 2025Article
- Retrograde Intramedullary Nailing vs. Lateral Locking Plate Fixation for Distal Femur Fractures: Which Technique is Superior?Orthopedic reviews · 2025Article
- Comparison of Three Internal Fixation Constructs for AO/OTA 33-A3 Distal Femoral Fractures: A Biomechanical Study.Bioengineering (Basel, Switzerland) · 2024Article
- Preventing Atrophic Long-Bone Nonunion: Retrospective Analysis at a Level I Trauma Center.Journal of clinical medicine · 2024Article
- Focus on the proximal femur.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThe distal femur comprises a wide intramedullary cavity and thin cortical bone. Firm internal fixation of comminuted fractures with displacement is challenging. Although many comparative studies have reported retrograde intramedullary nailing (RIN) and distal femoral plating (DFP) as the usual fixation methods for distal femoral fractures, no clear conclusion has been reached. Therefore, a meta-analysis and systematic review of the clinical and radiological results were conducted to determine the appropriate treatment method for distal femoral fractures.
methodsA systematic search of the PubMed, Embase, Scopus, and Cochrane Library databases from their inception to December 19, 2022, was performed using predefined criteria. Studies comparing the effects of RIN and DFP were considered. The analyzed outcome measures included duration of surgery, blood loss, time to union, delayed union, nonunion, malalignment, implant failure, infection, reoperation, limb length discrepancy, range of motion, persistent anterior knee pain, knee stiffness, and functional scores. Meta-analysis of pooled data was conducted using a random-effects model to determine the standard mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CIs).
resultsThirty-three studies with 2,432 patients were included. Compared to DFP, RIN was associated with a shorter time to fracture union (SMD, 1.83 months; 95% CI - 2.76 to - 0.90; P < 0.001) and a lower incidence of postoperative infection (OR 0.54; 95% CI 0.31-0.94; P = 0.03). Pooled analysis revealed no significant differences in other outcome measures between the two treatment modalities.
conclusionIn distal femoral fractures, RIN had a shorter bone union time and was more resistant to infection than DFP. However, there were no significant differences in the other clinical parameters. Therefore, the characteristics, strengths, and weaknesses of RIN and DFP should be carefully identified, and appropriate treatment should be provided based on the patient's medical condition and fracture pattern.
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