126 patients with a distal femur fracture were randomized to fixation through either retrograde nailing or locked plating. The purpose was to compare radiographic, functional, and clinical outcomes up to 1 year postoperatively. The results indicated a similar rate of malalignments, although plating was associated with a greater frequency of >5 degree valgus deformity. Functional outcomes did not significantly differ between groups over the one year follow-up. It was observed that while groups did not significantly differ, functional outcomes tended to be numerically better with nails.