Extra-articular distal femoral fractures typically occur in younger adults following high-energy trauma and are commonly treated with antegrade nailing, retrograde nailing, or plate fixation. In this study, we asked three key questions: Do these surgical methods result in different clinical and functional outcomes in patients under 60 years? If differences exist, do they persist at mid-term follow-up? How does each technique influence patients' quality of life?

To address this question, we conducted a retrospective case-control study of 117 patients treated between January 2015 and December 2022. Patients were allocated to three groups: AIMN (n = 38), RIMN (n = 39), and locking plate fixation (n = 40). Demographic and clinical data were analyzed, and functional and quality-of-life outcomes were assessed using the Lysholm and EQ-5D scales.

The mean follow-up was 70.76 ± 30.54 months (median: 76; range: 24–119). Knee flexion at final follow-up differed significantly among groups (p = 0.007). Functional outcomes measured by the Lysholm score also showed significant intergroup differences at both the first postoperative year and final follow-up (p = 0.030). Quality of life, assessed using the EQ-5D scale, showed no group differences at one year (p > 0.05). However, at final follow-up, the RIMN group had significantly poorer scores (p = 0.001).

In conclusion, all three surgical methods appeared to offer acceptable management options for extra-articular distal femur fractures in patients under 60 years of age. The comparatively lower functional and quality-of-life outcomes observed with retrograde nailing may point to certain limitations, though these findings should be interpreted with caution.

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