{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T07:25:42Z","timestamp":1768375542643,"version":"3.49.0"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction: Periprosthetic distal femur fractures (PDFF) after total knee arthroplasty (TKA) are increasing with the growth of arthroplasty volume and longevity of implants; reported incidences for primary TKA range from ~0.3% to 2.5%, underscoring a clinically meaningful burden. Comparative data suggest both retrograde intramedullary nailing (RIMN) and locked plating (LP) achieve acceptable union with broadly similar complication profiles, but uncertainty persists regarding construct-specific trade-offs.\n\nMaterials and Methods: We conducted a retrospective propensity-matched cohort study within the TriNetX U.S. Collaborative Network, a federated platform of de-identified electronic health records from dozens of U.S. health systems. Adult patients (\u226550 years) with PDFF around a stable knee prosthesis were identified using International Classification of Disease-10 (ICD-10) diagnosis and current procedural terminology\/ICD-10-procedure coding system procedure codes. The index event was the first qualifying fixation \u2013 RIMN or LP \u2013 with outcomes observed for 365 days post-index. Propensity score matching (1:1, greedy nearest neighbor without replacement) balanced age, sex, and comorbidities (e.g., diabetes, hypertension, cardiovascular, renal, pulmonary, hepatic disease, osteoporosis, obesity, tobacco use, depression, rheumatoid arthritis). Outcomes included revision\/re-operation, hardware removal, mechanical implant complications, deep infection, non-union\/malunion, re-fracture coding events, and venous thromboembolism (deep vein thrombosis\/pulmonary embolism [DVT\/PE]). We report risk difference (RD), risk ratio (RR, 95% confidence interval [CI]; P-matching RD P-values), and time-to-event hazard ratios (HR, 95% CI) from Kaplan\u2013Meier\/log-rank analyses. TriNetX governance ensures de-identification and standardized analytics.\n\nResults: After matching, 1,152 RIMN patients were compared with 1,152 LP patients with similar baseline characteristics and follow-up (median ~11\u201312 months). Revision\/re-operation within 1 year was uncommon and comparable (1.0% RIMN vs. 1.5% LP; RD\u22120.4%, P = 0.35; RR 0.71, 95% CI 0.34\u20131.47; HR 0.77, log-rank P = 0.49). Hardware removal occurred more often after RIMN (6.0% vs. 4.2%; RD + 1.8%, 95% CI 0.0\u20133.6%; P = 0.046; RR 1.44, 95% CI 1.00\u20132.06; HR 1.60, log-rank P = 0.012). Mechanical implant complications were less frequent with RIMN (3.6% vs. 5.6%; RD \u22122.0%, 95% CI \u22123.7\u2013\u22120.3%; P = 0.023; RR 0.65, 95% CI 0.44\u20130.94; HR 0.68, log-rank P = 0.047). Deep infection rates were similar (6.3% vs. 7.4%; RD \u22121.0%, P = 0.32; RR 0.86, 95% CI 0.64\u20131.16; HR 0.89, P = 0.48), as were non-union\/malunion (5.0% vs. 5.6%; RD \u22120.5%, P = 0.58; RR 0.91, 95% CI 0.64\u20131.28; HR 0.94, P = 0.75). DVT (4.6% vs. 6.2%; RD \u22121.6%, P = 0.097; RR 0.75, 95% CI 0.53\u20131.06; HR 0.77, P = 0.14) and PE (3.7% vs. 4.4%; RD \u22120.7%, P = 0.40; RR 0.84, 95% CI 0.57\u20131.26; HR 0.86, P = 0.46) did not differ significantly. These findings align with prior comparative literature showing broadly similar healing and complication rates between constructs, with nuanced differences by endpoint.\n\nConclusion: In a large real-world, propensity-matched cohort, RIMN and LP produced comparable 1-year union, infection, thromboembolism, and revision rates for PDFF after TKA. RIMN was associated with fewer mechanical implant failures but a higher frequency of elective hardware removal, reflecting a clinically relevant trade-off. Construct selection should be individualized to prosthesis design, fracture geometry, distal bone stock, and patient priorities. Findings complement prior meta-analyses and multicenter series and support shared decision-making rather than a one-size-fits-all approach.\n\nKeywords: Retrograde intramedullary nailing, Locked plating, Periprosthetic distal femur fracture, Total knee arthroplasty, Propensity score matching, Mechanical implant complications, Hardware removal<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i01.6690","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T02:55:37Z","timestamp":1768359337000},"page":"317-328","source":"Crossref","is-referenced-by-count":0,"title":["Retrograde Intramedullary Nailing Versus Locked Plating for Periprosthetic Distal Femur Fractures: A Propensity-matched Cohort from TriNetX"],"prefix":"10.13107","volume":"16","author":[{"name":"Department of Orthopaedics, Tameside and Glossop Integrated Care NHS Foundation Trust, Greater Manchester, United Kingdom,","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aamir","family":"Shahzad","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haji Bahar","family":"Ali","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Medicine, Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan,","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hasnain","family":"Chohan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Surgery, Northern Ireland Medical and Dental Training Agency, Belfast, United Kingdom,","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fouad","family":"Kaddour-Hocine","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Medicine, Bronx Care Health System, New York, United States,","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amna","family":"Shoaib","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Medicine, Al Nafees Medical College, Islamabad, Pakistan.","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ismail","family":"Pandor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Orthopaedics, Tameside and Glossop Integrated Care NHS Foundation Trust, Greater Manchester, United Kingdom,","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T02:55:37Z","timestamp":1768359337000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/01\/retrograde-intramedullary-nailing-versus-locked-plating-for-periprosthetic-distal-femur-fractures-a-propensity-matched-cohort-from-trinetx\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i01.6690","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]}}}