Gilbert William B, Moreno-Diaz Andres F, Maxson Ridge, Morris Cade A, Rodriguez-Baron Elsa, Yong Taylor M, Schaffer Nathaniel E, Obremskey William T, Mitchell Phillip M
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
Division of Orthopaedic Surgery, University of Texas El Paso, El Paso, TX, USA.
Injury. 2025 Aug;56(8):112442. doi: 10.1016/j.injury.2025.112442. Epub 2025 May 30.
Distal femur fractures are commonly managed with retrograde femoral nailing or locked lateral plating (LLP). As implant design has evolved, more distal and complex patterns are being treated with intramedullary implants. The aim of the present study was to compare early outcomes in distal femur fractures managed with the novel DePuy Synthes RFN-Advanced (RFNA) Retrograde Femoral Nailing System to a similar cohort treated with locked lateral plating.
This is a retrospective cohort study of operative distal femur fractures that presented to our Level I trauma center over a 7-year period. We included patients with AO/OTA types 33A2-3, 33C1-2 fractures treated with either the RFNA or a lateral locked plate over two distinct time points. Injury radiographs were reviewed independently by three orthopedic traumatologists to include only cases deemed "nailable." Primary outcomes included coronal and sagittal alignment. Secondary outcomes included nonunion, surgical site infection (SSI), and unplanned reoperation.
We identified 107 patients treated with either the RFNA (n = 45) or LLP (n = 62) over the 7-year study period. No significant differences were identified in the rates of sagittal (2.2 % versus 9.7 %, P = 0.12) or coronal malalignment (2.2 % versus 0 %, P = 0.421). The nonunion rate was 8.9 % in the RFNA cohort versus 19.4 % in the LLP cohort, but this difference was not statistically significant (P = 0.174). We also found no difference in infection or implant failure between groups. Screw backout occurred in 8 RFNA patients (17.8 %), with 7 patients undergoing screw removal (15.6 %) either in clinic (n = 5) or the operating room (n = 2).
This matched cohort study demonstrated promising results comparing the RFNA to lateral plating of distal femur fractures. The nonunion rate of 9 % in the RFNA cohort adds to recent literature that supports improved union rates with intramedullary nailing of these fractures. Interlocking screw backout was the most common complication with RFNA treatment at a rate of 16 %, with the majority removed in clinic.
Level III.
股骨远端骨折通常采用逆行股骨交锁髓内钉或锁定外侧钢板（LLP）治疗。随着植入物设计的不断发展，越来越多的远端及复杂骨折类型开始采用髓内植入物治疗。本研究的目的是比较采用新型DePuy Synthes RFN-Advanced（RFNA）逆行股骨交锁髓内钉系统治疗的股骨远端骨折患者与采用锁定外侧钢板治疗的类似患者群体的早期疗效。
这是一项对7年间在我院一级创伤中心接受手术治疗的股骨远端骨折患者的回顾性队列研究。我们纳入了在两个不同时间点接受RFNA或外侧锁定钢板治疗的AO/OTA 33A2-3型、33C1-2型骨折患者。由三名骨科创伤专家独立复查受伤时的X线片，仅纳入判定为“可使用髓内钉治疗”的病例。主要疗效指标包括冠状面和矢状面的对线情况。次要疗效指标包括骨不连、手术部位感染（SSI）和计划外再次手术。
在7年的研究期间，我们共确定了107例接受RFNA（n = 45）或LLP（n = 62）治疗的患者。矢状面畸形率（2.2%对9.7%，P = 0.12）或冠状面畸形率（2.2%对0%，P = 0.421）在两组间无显著差异。RFNA组的骨不连率为8.9%，LLP组为19.4%，但差异无统计学意义（P = 0.174）。我们还发现两组间在感染或植入物失败方面无差异。8例RFNA患者（17.8%）出现螺钉退出，其中7例患者（15.6%）在门诊（n = 5）或手术室（n = 2）接受了螺钉取出术。
这项配对队列研究表明，将RFNA与股骨远端骨折的外侧钢板固定术进行比较，结果令人满意。RFNA组9%的骨不连率进一步补充了近期的文献，这些文献支持采用髓内钉治疗此类骨折可提高骨愈合率。交锁螺钉退出是RFNA治疗最常见的并发症，发生率为16%，大多数在门诊取出。
三级。
