Outcome of Open Reduction Compared to Closed Reduction and Internal Fixation of Fracture Shaft of Femur with Intramedullary Interlocking Nailing in Adults

Abstract

Background: Fractures of the femoral shaft are among the most common and serious long bone injuries encountered in adult trauma patients. These fractures often result from high-energy trauma such as road traffic accidents or falls from significant heights and require prompt, stable fixation to restore limb function and minimize complications. This study aims to compare the clinical, radiological, and functional outcomes between open versus closed reduction techniques in intramedullary interlocking nailing for adult femoral shaft fractures. Methods: This prospective comparative study was conducted in the Department of Orthopaedics at Chittagong Medical College Hospital, from January 2019 to January 2022, including 100 adults (18–60 years) with diaphyseal femoral fractures. Patients were randomly assigned to two groups: Group A underwent closed reduction with intramedullary interlocking nailing, and Group B underwent open reduction with the same fixation technique. Result: Both open (Group A) and closed (Group B) reduction techniques demonstrated comparable baseline characteristics. Open reduction was associated with significantly longer operative time and greater intraoperative blood loss, whereas closed reduction required more fluoroscopy time. Although postoperative complications such as infection and delayed union were more frequent in the open group, the differences were not statistically significant. Radiological union times and functional outcomes at six months were also similar between groups, with the majority of patients achieving good to excellent results. Conclusion: This comparative study on the outcomes of open versus closed reduction and internal fixation of femoral shaft fractures using intramedullary interlocking nailing in adults demonstrated that closed reduction is associated with significantly better functional outcomes, shorter operative time, less blood loss, and reduced complication rates.