title: Nails or plates for fracture of the distal femur? data from the Victoria Orthopaedic Trauma Outcomes Registry.
abstract: OBJECTIVE
  Fractures of the distal femur are an important cause of morbidity. Their optimal management remains controversial. Contemporary implants include angular-stable anatomical locking plates and locked intramedullary nails (IMNs). We compared the long-term patient-reported functional outcome of fixation of fractures of the distal femur using these two methods of treatment.
  
  
  METHODS
  A total of 297 patients were retrospectively identified from a State-wide trauma registry in Australia: 195 had been treated with a locking plate and 102 with an IMN. Baseline characteristics of the patients and their fractures were recorded. Health-related quality-of-life, functional and radiographic outcomes were compared using mixed effects regression models at six months and one year.
  
  
  RESULTS
  There was a clinically relevant and significant difference in quality-of-life at six months in favour of fixation with an IMN (mean difference in EuroQol-5 Dimensions Score (EQ-5D) = 0.12; 95% CI 0.02 to 0.22; p = 0.025). There was weak evidence that this trend continued to one year (mean difference EQ-5D = 0.09; 95% CI -0.01 to 0.19; p = 0.073). There was a significant although very small reduction in angular deformity using an IMN (mean difference -1.02; 95% CI -1.99 to -0.06; p = 0.073). There was no evidence that there was a difference in any other outcomes at any time point.
  
  
  CONCLUSIONS
  IMN may be a superior treatment compared with anatomical locking plates for fractures of the distal femur. These findings are concordant with other data from pilot randomised studies which favour treatment of these fractures with an IMN. This study strongly supports the need for a definitive randomised trial. Cite this article: Bone Joint J 2016;98-B:846-50.
authors.affiliation: Royal Melbourne Hospital, Parkville 3050, Victoria, Australia and the Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville 3010, Victoria, Australia.
authors.forename: W
authors.initials: W
authors.lastname: Hoskins
authors.affiliation: Royal Melbourne Hospital, Parkville 3050, Victoria, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Sheehy
authors.affiliation: Monash University, Commercial Rd, Prahran, Victoria 3181, Australia.
authors.forename: E R
authors.initials: ER
authors.lastname: Edwards
authors.affiliation: The Northern Hospital, 185 Cooper Street, Epping, Victoria 3076, Australia.
authors.forename: R C
authors.initials: RC
authors.lastname: Hau
authors.affiliation: Royal Melbourne Hospital, Parkville 3050, Victoria, Australia and the Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville 3010, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Bucknill
authors.affiliation: University of Warwick, Coventry CV4 7AL, UK.
authors.forename: N
authors.initials: N
authors.lastname: Parsons
authors.affiliation: John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford OX3 9DU, UK.
authors.forename: X L
authors.initials: XL
authors.lastname: Griffin
mesh_terms: D001315:Australia; D001858:Bone Nails; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D012189:Retrospective Studies
keywords: Bone plates; Femur; Fracture fixation - intramedullary; Patient outcome assessment