Retrograde Intramedullary Nailing and Locked Plating for the Treatment of Periprosthetic Supracondylar Femur Fractures: A Meta-Analysis and Quantitative Review



1 University of Texas Medical Branch Galveston UTMB John Sealy School of Medicine, Texas, USA

2 Boston VA Medical center, Boston, MA, USA

3 Dallas VA Medical Center, Dallas, TX, USA

4 All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, India

5 Marshall Health, Huntington, USA


Background: As the prevalence of Total Knee Arthroplasty increases, there is still debate over the preferred method of 
treatment of supracondylar periprosthetic femoral fractures. The aim of this study was to compare two of the common 
methods of fixation: Locked Plating and Retrograde Intramedullary Nailing with respect to nonunion, delayed union and 
surgical revision rate.
Methods: A comprehensive database search via Pubmed was conducted, yielding 16 eligible studies. Six of those 
studies were comparative and were used in the meta-analysis section. All 16 studies were used in the pooled sample 
analysis section. The primary outcome analyzed was nonunion and delayed union rate while the secondary outcome 
was the surgical revision rate. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were calculated by 
comparing incidences of nonunion and delayed union, and surgical revision rates among the studies.
Results: The meta-analysis showed that there is no statistically significant difference among the two groups in terms of 
nonunion and delayed union rate (OR = 1.43, CI = 0.74, 2.74, P=0.28), but there is a significant difference in the surgical 
revision rate favoring locked plating over retrograde intramedullary nailing (OR = 2.71, CI = 1.42, 5.17, P=0.003). 
The pooled sample analysis showed that there is no significant difference in the nonunion and delayed union rates 
(P=0.210) or the surgical revision rates (P=0.038). 
Conclusion: Both locked plating and Retrograde Intramedullary Nailing are reliable options for treating supracondylar 
femoral fractures around Total Knee Arthroplasty. Locked plating demonstrated a trend towards decreased nonunion 
and delayed union rates and a significantly lower surgical revision rate in the meta-analysis. 
Level of evidence: IV