Comparative study on femoral shaft fracture treated by plate and screws versus intramedullary interlocking nails. A clinical study

Background and objective: Diaphyseal femoral fracture is injury that need reduction and fixation. The aim is to compare between treatment of diaphyseal femoral fracture by open and closed technique in primary outcome measures as union and malalignment; and secondary outcome measures as nerve injury, blood loss, exposure to fluoroscopy and infection. Methods: This cross-sectional study compares two groups of sixty-three patients, with DFF; group A (27patients) were treated by closed reduction by intramedullary interlocking nail and group B (36 patients) by open reduction and internal fixation by plate and screws. Both groups were followed up by union, malalignment, blood loss, nerve injury, infection, exposure to radiation and implant failure. Following surgery, both groups were evaluated at four weeks, six weeks, three months, six months, and one year. Results: there was significant association between type of operation and gender 88.9% of male patients were treated by group A technique while 63.9% of male patients treated by group B technique (P = 0.024), callus formation after 4 weeks 81.5% of group A cases callus formed after 4 weeks (P <0.001), union at 6 months 92.83% of group A united (P = 0.007),intra operative exposure to radiation 100% patients of group A exposed to fluoroscopy (P <0.001), blood transfusion 66.7% of group B cases transfused blood (P <0.001), nerve injury 100% of cases in group B did not have nerve injury (P = 0.029) and range of knee flexion at 6 months 88.9% of group A cases range of knee flexion was 0- ≥ 120 degrees (P = 0.004). Conclusion: This study found that closed reduction by intramedullary interlocking nail better than open reduction and internal fixation by plate and screws in callus formation after four weeks, union at six months, blood loss and range of knee flexion; while the open reduction and internal fixation by plate and screws was better than closed reduction by intramedullary interlocking nail in nerve injury and exposure to radiation.