Long-term functional outcomes after intra-articular distal femur fractures: ORIF versus retrograde intramedullary nailing.

This retrospective study evaluated the long-term clinical, functional, and radiographic outcomes of traditional open reduction internal fixation (ORIF) versus limited open reduction with retrograde intramedullary nailing of supracondylar-intercondylar distal femur fractures (Arbeitsgemeinschaft fur Osteosynthesefragen [AO] 33-C type). Twenty-three fractures were followed in 22 patients for a mean follow-up of 80 months. The rate of subsequent bone-grafting procedures (67% vs 9%) and malunion (42% vs 0%) were significantly higher in ORIF compared to the less invasive retrograde intramedullary nailing treatment. A nonsignificant trend was noted for increased infection (25% vs 0%) and nonunion (33% vs 9%) in the ORIF group. The physical function component of the SF-36 was approximately 2 standard deviations below the US population mean, and 50% of patients demonstrated radiographic changes of posttraumatic arthritis. No patient has had a subsequent total knee arthroplasty.