Interlocking intramedullary nailing in femoral shaft fractures: the effect of open or closed reduction on the results

Abstract

Objectives: We compared the results of interlocking intramedullary nailing after closed or open reduction of femoral shaft fractures.
Patients and methods: The study included 179 femoral shaft fractures of 170 patients (98 males, 72 females; mean age 37 years; range 18 to 82 years). The fractures were classified according to the Winquist-Hansen classification. All the patients underwent reamed interlocking intramedullary nailing after closed (n=101) or open (n=78) reduction. The two groups were compared with regard to operation time, amount of bleeding, union time, delayed union and nonunion rates, infections, and functional results.
Results: The mean operation time (137±21 min) and the mean amount of bleeding (421±50 ml) were significantly increased in the open reduction group, which were 115±36 min and 296±44 ml in the closed reduction group (p<0.001). Union was achieved in 172 fractures (96.1%) after a mean of 21.3±5.5 weeks, being 19.6±5.0 weeks and 23.6±5.6 weeks with closed and open reductions, respectively (p<0.001). Delayed union was observed in nine (8.9%) and 15 (19.2%) fractures with closed and open reductions, respectively (p<0.05). Nonunion rates were similar, with two fractures (2%) in closed reduction, and five fractures (5%) in open reduction (p>0.05). Infection rates were (3.0%) with three superficial infections after closed reduction, and (10.3%) with six superficial and two deep infections after open reduction (p<0.05).
Conclusion: Open reduction of femoral shaft fractures treated with intramedullary nailing is associated with prolonged operation time, increased bleeding, a higher rate of secondary operations due to increased delayed union, and a higher infection rate.