Functional recovery and quality of life after surgical fixation of segmental femoral shaft fractures: a case series from India

Segmental femoral shaft fractures, which are often a result of high-energy trauma, pose significant challenges in management and rehabilitation. This case series presents twelve male patients (mean age 40 years, range 28-52) with segmental femoral shaft fractures treated between October 2022 and March 2023 at tertiary care centers in Tamil Nadu, India. Surgical fixation methods included intramedullary interlocking nails (58.3%), locking plates (25%), and other constructs (16.7%), with all patients undergoing open reduction. Functional recovery and quality of life were assessed using WOMAC, EQ-5D-3L, and SMFA scores at 1, 3, and 6 months postoperatively. Significant improvements were observed across all measures, with mean WOMAC scores decreasing from 55.6 (±6.5) to 18.2 (±5.9), EQ-5D-3L scores improving from 0.62 (±0.10) to 0.91 (±0.06), and SMFA dysfunction index decreasing from 41.4 (±5.3) to 12.6 (±3.9) over six months. Radiological union was achieved in 33.3% of cases at 3 months and in all remaining eleven patients (one lost to mortality from associated injuries) by 6 months, with a mean union time of 23.7 weeks. This case series demonstrates that appropriate surgical fixation of segmental femoral shaft fractures can yield favorable functional outcomes and quality of life improvements, with complete radiological union achievable within six months in this challenging fracture pattern.