{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T10:09:52Z","timestamp":1793095792359,"version":"4.5.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"\n OBJECTIVES:<\/jats:title>\n To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN + plate constructs for native distal femur fractures.<\/jats:p>\n <\/jats:sec>\n \n METHODS:<\/jats:title>\n <\/jats:sec>\n \n Design:<\/jats:title>\n Retrospective review of operative distal femur fractures, 2018\u20132022.<\/jats:p>\n <\/jats:sec>\n \n Setting:<\/jats:title>\n Urban level 1 trauma center.<\/jats:p>\n <\/jats:sec>\n \n Patient Selection Criteria:<\/jats:title>\n Included were patients >18 years old with AO\/OTA 33A or 33C distal femur fractures and \u22656 months follow-up.<\/jats:p>\n <\/jats:sec>\n \n Outcome Measures and Comparisons:<\/jats:title>\n \n Demog\n r<\/jats:bold>\n aphics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST \u226510), reoperations, complications, and return to weightbearing were collected and compared between the 3 fixation constructs.\n <\/jats:p>\n <\/jats:sec>\n \n RESULTS:<\/jats:title>\n \n One hundred thirty-seven patients were included (71 rIMN, 27 plate, 39 rIMN + plate). Median age was older for rIMN + plate than for rIMN (61 vs. 54 years,\n P<\/jats:italic>\n = 0.015) and similar between rIMN + plate and plate groups (61 years for both,\n P<\/jats:italic>\n = 0.68). There were no other differences in demographics among groups (\n P<\/jats:italic>\n > 0.05). The rIMN + plate group had longer operative time (256 minutes) and higher EBL (250cc) than rIMN alone (150 minutes,\n P<\/jats:italic>\n = 0.0006 and 200cc,\n P<\/jats:italic>\n = 0.023) and similar operative time and EBL compared with plate alone (168 minutes,\n P<\/jats:italic>\n = 0.071 and 250cc,\n P<\/jats:italic>\n = 0.73) There were no differences in final coronal or sagittal alignment (\n P<\/jats:italic>\n = 0.78,\n P<\/jats:italic>\n = 0.87, respectively) or reoperation rates (\n P<\/jats:italic>\n = 0.74) among groups. The rIMN + plate group showed a higher rate of radiographic union (66.7%) than the rIMN (42.3%) and plate (44.4%) groups (\n P<\/jats:italic>\n = 0.042). When controlling for patient age, time to weightbearing was similar among the groups (\n P<\/jats:italic>\n = 0.79).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Although the rIMN + plate combination led to higher rates of union, it did not decrease time to weightbearing or reoperation rates compared with rIMN alone, and was associated with longer operative time and greater blood loss.<\/jats:p>\n <\/jats:sec>\n \n LEVEL OF EVIDENCE:<\/jats:title>\n Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/bot.0000000000003064","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T15:01:52Z","timestamp":1756998112000},"page":"653-660","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Nail Alone Results in Similar Clinical Outcomes With Less Perioperative Morbidity Compared With Nail Plate Combination in Treatment of Native Distal Femur Fractures"],"prefix":"10.1097","volume":"39","author":[{"given":"Maria","family":"Kammire","sequence":"first","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aseel","family":"Dib","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madeline","family":"Rieker","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"},{"name":"Wake Forest University School of Medicine, Charlotte, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Serbin","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Arendale","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziqing","family":"Yu","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel B.","family":"Seymour","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"},{"name":"Wake Forest University School of Medicine, Charlotte, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suman","family":"Medda","sequence":"additional","affiliation":[{"name":"Atrium Health Musculoskeletal Institute, Department of Orthopaedic Surgery, Charlotte, NC; and"},{"name":"Wake Forest University School of Medicine, Charlotte, NC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Evidence-Based Musculoskeletal Injury and Trauma Collaborative (EMIT)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20251204","doi-asserted-by":"crossref","first-page":"e867","DOI":"10.5435\/JAAOS-D-17-00706","article-title":"Modern implant options for the treatment of distal femur fractures","volume":"27","author":"Hake","year":"2019","journal-title":"J Am Acad Orthop Surg."},{"key":"R2-20251204","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","article-title":"Epidemiology of adult fractures: a review","volume":"37","author":"Court-Brown","year":"2006","journal-title":"Injury"},{"issue":"suppl 1","key":"R3-20251204","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1097\/BOT.0b013e3182070127","article-title":"Locking plates for distal femur fractures: is there a problem with fracture healing?","volume":"25","author":"Henderson","year":"2011","journal-title":"J Orthop Trauma"},{"key":"R4-20251204","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s11999-010-1530-2","article-title":"Mortality after distal femur fractures in elderly patients","volume":"469","author":"Streubel","year":"2011","journal-title":"Clin Orthop Relat Res."},{"key":"R5-20251204","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s00402-004-0779-x","article-title":"Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study","volume":"125","author":"Sch\u00fctz","year":"2005","journal-title":"Arch Orthop Trauma Surg."},{"key":"R6-20251204","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1302\/0301-620X.98B6.36826","article-title":"Nails or plates for fracture of the distal femur? Data from the Victoria orthopaedic trauma outcomes registry","volume":"98-B","author":"Hoskins","year":"2016","journal-title":"Bone Jt J"},{"key":"R7-20251204","first-page":"e23617","article-title":"Evaluation of the results of minimally invasive plate osteosynthesis using a locking plate in the treatment of distal femur fractures","volume":"14","author":"Abdelmonem","year":"2022","journal-title":"Cureus"},{"key":"R8-20251204","first-page":"61","article-title":"Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation","volume":"30","author":"Henderson","year":"2010","journal-title":"Iowa Orthop J."},{"key":"R9-20251204","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1097\/BOT.0b013e31829e6dd0","article-title":"Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases","volume":"28","author":"Ricci","year":"2014","journal-title":"J Orthop Trauma"},{"key":"R10-20251204","doi-asserted-by":"crossref","first-page":"e026810","DOI":"10.1136\/bmjopen-2018-026810","article-title":"Intramedullary nails versus distal locking plates for fracture of the distal femur: results from the trial of acute femoral fracture fixation (TrAFFix) randomised feasibility study and process evaluation","volume":"9","author":"Griffin","year":"2019","journal-title":"BMJ Open"},{"key":"R11-20251204","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta23510","article-title":"Retrograde intramedullary nail fixation compared with fixed-angle plate fixation for fracture of the distal femur: the TrAFFix feasibility RCT","volume":"23","author":"Griffin","year":"2019","journal-title":"Health Technol Assess."},{"key":"R12-20251204","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1007\/s00167-016-4050-0","article-title":"Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis","volume":"25","author":"Shin","year":"2017","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"R13-20251204","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1097\/BOT.0000000000000391","article-title":"Early mechanical failures of the synthes variable angle locking distal femur plate","volume":"30","author":"Tank","year":"2016","journal-title":"J Orthop Trauma"},{"key":"R14-20251204","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1007\/s00264-017-3460-z","article-title":"Intramedullary nail versus volar locking plate fixation for the treatment of extra-articular or simple intra-articular distal radius fractures: systematic review and meta-analysis","volume":"41","author":"Zhang","year":"2017","journal-title":"Int Orthop."},{"key":"R15-20251204","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1055\/s-0039-1683444","article-title":"Nail-plate constructs for periprosthetic distal femur fractures","volume":"32","author":"Mirick Mueller","year":"2019","journal-title":"J Knee Surg."},{"key":"R16-20251204","doi-asserted-by":"crossref","first-page":"e172","DOI":"10.1097\/OI9.0000000000000172","article-title":"Distal femur: nail plate combination and the linked construct","volume":"5","author":"Liporace","year":"2022","journal-title":"OTA Int."},{"key":"R17-20251204","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.injury.2022.11.035","article-title":"Nail plate combination in fractures of the distal femur in the elderly: a new paradigm for optimum fixation and early mobilization?","volume":"54","author":"Kontakis","year":"2023","journal-title":"Injury"},{"key":"R18-20251204","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1007\/s00590-022-03337-5","article-title":"The geriatric distal femur fracture: nail, plate or both?","volume":"33","author":"Wilson","year":"2023","journal-title":"Eur J Orthop Surg Traumatol."},{"key":"R19-20251204","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s00402-024-05723-6","article-title":"Nail-plate combination constructs versus single traditional constructs for distal femur fractures: a systematic review and meta-analysis of comparative studies","volume":"145","author":"Baumann","year":"2024","journal-title":"Archives Orthop Trauma Surg"},{"key":"R20-20251204","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.ocl.2019.08.007","article-title":"Acute distal femoral replacement for fractures about the knee in the elderly","volume":"51","author":"Rice","year":"2020","journal-title":"Orthop Clin North Am."},{"key":"R21-20251204","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1097\/BOT.0000000000002905","article-title":"Temporary reduction assisting corridor constraint wires for intramedullary nailing of periarticular fractures: a technical trick and case series","volume":"38","author":"Serbin","year":"2024","journal-title":"J Orthop Trauma"},{"key":"R22-20251204","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1302\/2633-1462.210.BJO-2021-0071.R1","article-title":"Sensitivity and specificity of modified RUST score using clinical and radiographic findings as a gold standard","volume":"2","author":"Plumarom","year":"2021","journal-title":"Bone Jt Open"},{"key":"R23-20251204","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris","year":"2009","journal-title":"J Biomed Inf."},{"key":"R24-20251204","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1159\/000342664","article-title":"Retrograde nailing versus locked plating of extra-articular distal femoral fractures: comparison of 36 cases","volume":"22","author":"Gao","year":"2013","journal-title":"Med Princ Pract."},{"key":"R25-20251204","first-page":"Rc19","article-title":"Extra articular supracondylar femur fractures managed with locked distal femoral plate or supracondylar nailing: a comparative outcome study","volume":"11","author":"Gill","year":"2017","journal-title":"J Clin Diagn Res."},{"key":"R26-20251204","doi-asserted-by":"crossref","first-page":"521","DOI":"10.3944\/AOTT.2014.14.0004","article-title":"Comparison of retrograde intramedullary nailing and bridge plating in the treatment of extra-articular fractures of the distal femur","volume":"48","author":"Demirta\u015f","year":"2014","journal-title":"Acta Orthop Traumatol Turc"},{"key":"R27-20251204","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/01.blo.0000141935.86481.ba","article-title":"Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications?","volume":"426","author":"Markmiller","year":"2004","journal-title":"Clin Orthop Relat Res."},{"key":"R28-20251204","doi-asserted-by":"crossref","first-page":"243","DOI":"10.4103\/0019-5413.80043","article-title":"Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: a retrospective analysis","volume":"45","author":"Hierholzer","year":"2011","journal-title":"Indian J Orthop."},{"key":"R29-20251204","doi-asserted-by":"crossref","first-page":"1170","DOI":"10.1016\/j.injury.2012.03.023","article-title":"Retrograde nailing and compression bolts in the treatment of type C distal femoral fractures","volume":"43","author":"Garnavos","year":"2012","journal-title":"Injury"},{"key":"R30-20251204","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1007\/s00402-019-03193-9","article-title":"Weight-bearing restrictions reduce postoperative mobility in elderly hip fracture patients","volume":"139","author":"Pfeufer","year":"2019","journal-title":"Arch Orthop Trauma Surg."}],"container-title":["Journal of Orthopaedic Trauma"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003064","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T13:01:11Z","timestamp":1764853271000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/BOT.0000000000003064"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":30,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/bot.0000000000003064","relation":{},"ISSN":["0890-5339","1531-2291"],"issn-type":[{"value":"0890-5339","type":"print"},{"value":"1531-2291","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]},"assertion":[{"value":"2025-08-28","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}