A Comparison of Complications and Union Rates in Intramedullary Nailing of Femoral Shaft Fractures Treated With Open Versus Closed Reduction.

Intramedullary rod fixation is a common technique for treatment of femoral shaft fractures, with both open and dosed reduction techniques described. The purpose of this study was to assess union and complication rates among patients treated with open vs closed reduction and intramedullary nailing of closed femoral shaft fractures. A total of 107 patients undergoing intramedullary fixation of nonpathologic femoral shaft fractures (AO/OTA type 32) between January 2012 and June 2017 were retrospectively studied. Those undergoing open reduction prior to intramedullary nailing were compared with those undergoing closed reduction. The primary outcome analyzed was union rate. Secondary outcomes were time to union, complications necessitating return to the operating room, and operative times. Mean follow-up was 14 months in both groups (range, 6-48 months). Of the 107 patients, 34.6% (n=37) underwent open reduction and 65.4% (n=70) underwent closed reduction. Patients in the open reduction group had rates of union (89.1%, 33 of 37) similar to those of patients in the closed reduction group (92.9%, 65 of 70; P=.378). Patients in the open reduction group who had union did so in a mean of 6.2 months (range, 3-12 months) vs a mean of 5.4 months (range, 2-11 months) in the closed reduction group (P=.13). Six patients (16.2%) in the open reduction group and 6 patients (8.6%) in the closed reduction group had a postoperative complication requiring return to the operating room (P=.18). Open reduction and intramedullary nailing results in rates of union, time to union, and rates of significant complications similar to those of closed reduction and intramedullary nailing.