Objective:To investigate the long-term effects of retrograde intramedullary nailing and locking plate fixation in the treatment of distal femoral fracture in the elderly.Methods:According to different treatment methods,128 elderly patients were divided into the retrograde intramedullary nailing group(n=51)and the locking plate fixation group(n=77).Perioperative indicators were compared between the two groups.1 year of follow-up later,joint function,self-care ability,and the occurrence of complications in the two groups were compared.Results:Surgery time,intraoperative blood loss and surgical incision of the retrograde intramedullary nailing group were significantly shorter and less than those of the locking plate fixation group(P<0.05).The knee joint function scale(HSS),Babbitt index(BI),and activities of daily living(ADL)scores of the retrograde intramedullary nailing group were higher than those of the locking plate fixation group(P<0.05).The total incidence of complications in the retrograde intramedullary nailing group in 1 year after surgery was lower than that in the locking plate fixation group(P<0.05).Conclusion:Retrograde intramedullary nail-ing can effectively shorten surgery time,reduce intraoperative blood loss,shorten surgical incision,improve knee function,and enhance self-care ability of elderly patients with distal femoral fractures,with fewer complications.