Clinical Outcomes of Intramedullary Interlocking Nailing via Open and Closed Reduction in AO Type 32A1–B2 Femoral Shaft Fractures: A Quasi-Experimental Study

Abstract

Background: Shaft fractures of the femur are among the most common orthopedic injuries, and intramedullary interlocking nailing has been established as the gold standard of treatment. However, the optimal reduction technique - open or closed reduction - remains contentious. This study aimed to compare the clinical outcomes of the open and closed reduction techniques for intramedullary interlocking nailing in AO type 32A1-B2 femoral shaft fractures. Methods: A quasi-experimental study was conducted at NITOR & SOMC, Dhaka, Bangladesh, from January 2021 to December 2022. Seventy adult patients (18-60 years) with AO type 32A1-B2 femoral shaft fractures were randomly assigned to two equal groups: closed reduction (n=35) and open reduction (n=35). Patients were observed at 2-, 6-, 12-, and 24-week post-surgery. Primary outcomes were time to union, infection rates, implant-related complications, and functional outcomes. Binary logistic regression analysis was carried out to identify independent predictors of successful union. Results: The closed reduction group had shorter time to union (16.8 ± 2.9 vs. 18.7 ± 3.4 weeks, p<0.05) and lower infection rates (2.9% vs. 14.3%) when compared to the open reduction group. The closed reduction group also had improved functional results, with 80% having full knee motion compared with 62.9% in the open reduction group. Implant-related complications were relatively fewer in the closed reduction group (8.6% vs. 20.0%). Logistic regression revealed that open reduction reduced the odds of union by 55% (AOR: 0.45, 95% CI: 0.21-0.93, p=0.031). Conclusion: Closed reduction for intramedullary interlocking nailing of AO type 32A1-B2 femoral shaft fractures has superior clinical outcomes like earlier union, fewer infections, and better functional outcome compared to open reduction, warranting its preference whenever technically feasible.