Complications after intramedullary nailing of diaphyseal femur fractures in a level I trauma center in Finland

Objective: To investigate the effect of high versus low trauma energy on the risk of medical and surgical complications after intramedullary nailing of femoral diaphyseal fractures, and to determine the overall rates of these complications. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients: The study included 279 patients with 289 fractures who underwent primary surgery with a locked reamed rigid intramedullary nail for diaphyseal femoral fractures between May 2007 and May 2022 at a Level 1 trauma center in Finland, with follow-up assessments organized within the same hospital district. Main Outcome Measurements: Complications were recorded from chart review. To investigate the effect of trauma energy on complication risk, the proportions of complications in high- and low-energy groups were compared, and odds ratios were calculated. The mean follow-up period of the study population was 8 years (range, 12 months to 15 years). Results: The crude percentage of 30-day mortality was 2.1% (6 of 289), and overall complications occurred in 22.5% of cases. The risk for any medical complication was 2.8%, whereas surgical complications occurred in 19.8%. Interestingly, the risk for complications was nearly twice as high in high-energy fractures compared with low-energy fractures (odds ratio 1.92, 95% confidence interval, 1.03–3.75). Furthermore, the risk for reoperation was significantly higher in high-energy traumas (odds ratio 2.46, confidence interval, 1.25–5.24). Conclusions: This study reveals a 2.1% risk for 30-day mortality and a 22.5% risk for overall complications, primarily surgical. The complication risk, especially for surgical complications, is higher in high-energy fractures compared with low-energy ones, highlighting the importance of the timely identification of such complications to improve postoperative care. Level of Evidence: IV.