Background: Distal femur fractures, including supracondylar and distal third femoral fractures, account for approximately 3–7% of all femoral fractures and are associated with significant morbidity due to complex anatomy and biomechanical challenges. Retrograde intramedullary interlocking nailing has emerged as an effective treatment modality offering stable fixation with minimal soft tissue disruption.

Aim: To evaluate the clinical, functional, and radiological outcomes of supracondylar and distal third femur fractures treated with retrograde intramedullary interlocking nail using Neer’s criteria, and to assess postoperative rehabilitation outcomes.

Materials and Methods: This prospective study was conducted at Karnataka Institute of Medical Sciences between September 2024 and September 2025. A total of 25 patients with closed supracondylar and distal third femur fractures above 18 years of age were included. All patients underwent closed reduction and internal fixation using retrograde intramedullary interlocking nail. Functional and radiological outcomes were assessed using Neer’s criteria during follow-up.

Results: The mean age of patients was 42 years, with males constituting 80% of cases. Road traffic accidents were the most common mode of injury (72%). According to AO classification, type 33A2 fractures were most common (64%). Functional outcomes based on Neer’s criteria were excellent in 52% of patients, good in 36%, fair in 8%, and poor in 4%. Mean duration of surgery was 82 minutes with average blood loss of 256 ml. All fractures achieved union, with average union time of 4.5 months. Dynamisation was required in 16% of cases. Most patients achieved satisfactory knee range of motion, with minimal complications.

Conclusion: Retrograde intramedullary interlocking nailing is an effective and reliable method for management of supracondylar and distal third femur fractures. It provides stable fixation, early mobilization, satisfactory functional recovery, and good radiological union with minimal soft tissue disruption and acceptable complication rates.