Robert P Dunbar1, Kenneth A Egol2, Clifford B Jones3, Jan P Ertl4, Brian Mullis4, Edward Perez5, Cory A Collinge6, Robert Ostrum7, Catherine Humphrey8, Michael J Gardner9, William M Ricci10, Laura S Phieffer11, David Teague12, William Ertl12, Christopher T Born12, Alan Zonno13, Jodi Siegel7, H Claude Sagi14, Andrew Pollak15, Andrew H Schmidt16, David Templeman16, Andrew Sems17, Darin M Friess18, Hans-Christoph Pape19, James C Krieg20, Paul Tornetta21. 1. Harborview Medical Center/University of Washington, Seattle, WA. 2. New York University/Hospital for Joint Diseases, New York, NY. 3. Creighton University Medical, Dignity Health Phoenix, AZ. 4. Indiana University Medical Center, Indianapolis, IN. 5. The Campbell Clinic, Nashville TN. 6. Orthopaedic Specialty Associates, Fort Worth, TX. 7. University of North Carolina, Chapel Hill, NC. 8. University of Rochester Medical Center, Rochester, NY. 9. Stanford University School of Medicine, Palo Alto, CA. 10. Hospital for Special Surgery, New York, NY. 11. The Ohio State University Wexner Medical Center, Columbus, OH. 12. University of Oklahoma Medical Center, Oklahoma City, OK. 13. Rhode Island Hospital, Brown University, Providence, RI. 14. University of Cincinnati Medical Center, Cincinnati, OH. 15. R Adams Cowley Shock Trauma Center/University of Maryland Baltimore, Baltimore, MD. 16. Hennepin County Medical Center, Minneapolis, MN. 17. Mayo Clinic Hospital, St. Mary's Campus, Rochester, MN. 18. Oregon Health and Science University Hospital, Portland, OR. 19. University of Pittsburgh Medical Center, Pittsburgh, PA. 20. Rothman Orthopaedic Institute, Philadelphia, PA. 21. Boston University Medical Center, Boston, MA.
Abstract
OBJECTIVES: The main two forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment. DESIGN: Prospective, multicenter randomized controlled trial. SETTING: 20 academic trauma centersPatients/Participants: 160 patients with distal femur fractures were enrolled. 126 patients were followed 12 months. Patients were randomized to plating in 62 cases and to intramedullary nailing in 64 cases. INTERVENTION: Lateral locked plating or retrograde intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Functional scoring including SMFA, Bother Index, EQ Health and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs and number and type of adverse events. RESULTS: Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months post injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability & ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups. CONCLUSIONS: Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year following injury, but remain impaired one year post operatively. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
OBJECTIVES: The main two forms of treatment for distal femur fractures are locked lateral plating and retrograde nailing. The goal of this trial was to determine whether there are significant differences in outcomes between these forms of treatment. DESIGN: Prospective, multicenter randomized controlled trial. SETTING: 20 academic trauma centersPatients/Participants: 160 patients with distal femur fractures were enrolled. 126 patients were followed 12 months. Patients were randomized to plating in 62 cases and to intramedullary nailing in 64 cases. INTERVENTION: Lateral locked plating or retrograde intramedullary nailing. MAIN OUTCOME MEASUREMENTS: Functional scoring including SMFA, Bother Index, EQ Health and EQ Index. Secondary measures included alignment, operative time, range of motion, union rate, walking ability, ability to manage stairs and number and type of adverse events. RESULTS: Functional testing showed no difference between the groups. Both groups were still significantly affected by their fracture 12 months post injury. There was more coronal plane valgus in the plating group, which approached statistical significance. Range of motion, walking ability & ability to manage stairs were similar between the groups. Rate and type of adverse events were not statistically different between the groups. CONCLUSIONS: Both lateral locked plating and retrograde intramedullary nailing are reasonable surgical options for these fractures. Patients continue to improve over the course of the year following injury, but remain impaired one year post operatively. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.