Comparison of Short-Term Clinical Outcomes of the DePuy Synthes Femoral Reconstruction Nail with the Synthes Expert Retrograde/Antegrade Femoral Nail for Intramedullary Nailing in Femoral Shaft Fractures

Objectives The objective of this study is to compare the complications, rates of reoperation, and related secondary measures between two devices used to manage femoral shaft fractures: the DePuy Synthes Femoral Recon Nail (FRN) and its predecessor, the DePuy Synthes Expert Retrograde/Antegrade Femoral Nail (R/AFN). The primary null hypothesis was that the two devices had no significant difference in the clinical outcomes. Our secondary hypothesis was that there is no significant difference in the duration of surgery between the two devices. Methods This study reviewed charts of all patients aged 18-89 who underwent antegrade intramedullary nailing for a femoral shaft fracture, subtrochanteric femur fracture, or a combined femoral neck/shaft fracture with either a FRN or a R/AFN from January 1st, 2010, to April 1st, 2022, at a single level 1 trauma center. A total of 88 subjects were identified for study inclusion: 30 patients who underwent fixation with the R/AFN system and 58 patients who received treatment with the FRN system. These subjects’ charts and radiographs were then analyzed for patient characteristics, fracture characteristics, radiographic outcomes, and clinical outcomes. Statistical significance between variables was ascertained using chi-squared analysis and t-tests. Significant results were confirmed via power analysis with a two-sample t-test and normalization for demographic differences using linear regression. Results Average body mass indexes (BMIs) were 24.6±4.4 kg/m2 and 27.9±4.6 kg/m2 for the R/AFN and FRN groups, respectively (P=.002). The duration of surgery was 2.4±1.0 hours for the R/AFN cohort and 3.1±1.1 hours for the FRN cohort (P=.01). No statistically significant differences were found in the clinical outcomes between the two devices. Conclusion The FRN has short-term clinical outcomes comparable to the R/AFN in terms of safety and efficacy.