Radiographic Outcomes of Treatment of Complex Femoral Shaft Fractures by Intramedullary Nailing: A Retrospective Analysis of Different Techniques

Background This study aimed to determine whether the outcomes of femoral diaphyseal fractures (AO/OTA/32-C) were dependent on the treatment technique (closed vs. open reduction and internal fixation with an interlocking nail).This retrospective study was conducted at a level III trauma center. A total of 47 consecutive patients with femoral diaphyseal fractures (AO/OTA/32-C) were included. All patients underwent reduction and fixation and were divided into two groups according to the surgical techniques used: closed reduction and open reduction groups. The radiographic union score of the femur, mean union time, re-operation rate, and complication rate were assessed. Results At 12 postoperative months, the union rate was 80.76% in the open reduction group and 82.35% in the closed reduction group; however, the difference was not significant ( p =0.787). The rate of anatomical-to-small gaps was 96.15% and 47.05% in the open and closed reduction groups, respectively ( p =0.01). The radiographic union score of the femur at 6 postoperative months (9.30 vs. 7.76, p =0.02) and postoperative months (9.94 vs. 10.80, p =0.03) was significantly higher in the open reduction group. Further, the required time to union in the open reduction group was significantly shorter (7.39 vs. 9.18 months, p =0.025). The difference in the need for revision surgery was not significant between the two groups (19.23% vs. 23.52%, p =0.964). Conclusions Compared to closed reduction, intramedullary nailing of severe comminuted femoral shaft fractures with open reduction has similar outcomes and carries no increased risk of complications. Surgeons should consider open reduction if the outcomes of closed reduction are not satisfactory. This will aid in restoring anatomical reduction, enable primary bone grafting, and result in an optimal union rate, better strength of union, and shorter time to union.