Clinical, functional and radiological outcome of retrograde femoral nailing in femoral shaft fractures: an observational study

Background: Femoral shaft fractures require prompt and effective management to prevent long-term disability. Retrograde intramedullary nailing (RIMN) offers a reliable alternative to antegrade nailing, particularly when proximal access is limited. This study evaluates the clinical, functional, and radiological outcomes of RIMN to inform optimal fracture management. Methods: An ambispective observational study was conducted at the Asian Orthopaedic Institute, SIMS Hospital, Chennai, from February 2023 to February 2024. A total of 38 patients with femoral shaft fractures treated using RIMN were included. Functional outcomes were assessed using the lower extremity functional scale (LEFS), pain using the Visual Analogue Scale (VAS), and radiological outcomes based on time to union. All patients were operated on by the same surgeon and followed for six months postoperatively. Results: The mean age was 42.3±0.9 years, with a female predominance (55%). Slip and fall was the most common cause (53%), and A1-type fractures were most frequent. The mean time to union was 14.5±4.4 weeks. LEFS scores improved from 23.76 to 63.29, VAS scores declined from 4.95 to 0.34, and knee ROM increased from 77.37° to 112.63° (p<0.001). One malunion was reported; no other complications occurred. No significant association was found between demographic variables and time to union. Conclusion: RIMN is a safe and effective treatment for femoral shaft fractures, enabling early mobilization and favourable clinical outcomes.