A prospective study of closed and open reamed intramedullary nailing of 136 femoral shaft fractures in adults.

BACKGROUND: Femoral shaft fractures are major causes of mortality and morbidity and are managed with intramedullary nailing (IMN). In this study we compared the results of open and closed nailing in femoral shaft fractures. METHODS: Between 1993 and 2001 we managed 136 femoral shaft fractures by IMN (81 closed and 55 open nailings) in 120 patients with mean age of 36.2 years. The mean time of follow up was two years. Radiologic and clinical results were analyzed with SPSS software using student-t and Fisher test. RESULTS: 93.2% healed within six months. 2.9% required dynamization; total union rate was 96%. Full weight bearing was permitted between 5-16 weeks (mean of 10.62 weeks) in the closed method, and 10-20 weeks (mean of 12.83 weeks) in the open method (P 0.001). Complications included 4.41% nonunions, 2.9% shortening, 10.8% limited range of movement, 1.47% deep infection, and 6.6% malunion. Nonunion was observed in 2 cases in closed and in 4 patients in open method (P = 0.039). Closed series showed higher rate of malunion (P = 0.181, P = 0.221). CONCLUSIONS: In closed method attention should be paid to malalignment while locking the nail.