Femoral shaft fractures treated by intramedullary nail and plate osteosynthesis: a multi-center study in Jiangxi Province

Objective To compare the clinical outcomes of intramedullary nail versus plate osteosynthesis for the treatment of femoral shaft fractures in the adult patients in Jiangxi Province,China.Methods A retrospective investigation was conducted to review the 390 patients with femoral shaft fracture (410 sides) who had been treated from January 2007 to December 2009 and completely followed up in 5 major hospitals in Jiangxi Province,China.In the plate osteosynthesis group,there were 257 cases (271 sides),197 men and 60 women.In the intramedullary nail osteosynthesis group,there were 133 cases (139 sides),108 men and 25 women.The 2 groups were compared in terms of operation time,surgical bleeding,postoperative hospital stay,ambulant time,postoperative complications and Karlstr(o)m-Olerud score at the last follow-up.Results The nail group had significantly longer operation time (149.2 minutes ± 27.9 minutes vs.120.2 minutes ± 28.1 minutes) and significantly more surgical bleeding (459.7 mL ± 108.8 mL vs.429.9 mL ±13.7 mL) than the plate group ( P ＜ 0.05).There were no significantly differences regarding hospitalization time [(13.7±5.2) d vs.(14.1±5.6)d],ambulanttime[(3.5±0.9) months vs.(3.7±0.9) months],complications (43/257 vs.15/133) or Karlstr(o)m-Olerud score (232/257 vs.125/133) between the 2 groups ( P ＞0.05),but the failure of internal fixation in the plate group (17/257) was significantly higher than in the nail group (1/133) [OR=9.24,95％ CI(1.22,70.14),P=0.03].Conclusions Our study reveals that the outcomes of intramedullary nail and plate osteosynthesis are both satisfactory,but the intramedullary nail osteosynthesis is used much less and yields less satisfactory outcomes in treatment of femoral shaft fracture in Jiangxi Province than in the advanced hospitals in other regions of China and the world. Key words: Femoral fractures;  Fracture fixation, internal;  Bone plates;  Bone nails