Radiological Outcome Analysis of Comminuted Femoral Shaft Fractures: Locking Plate Versus Open Interlocking Intramedullary Nail

Abstract

Background: Comminuted femoral shaft fractures present significant challenges in orthopedic trauma management, particularly in low-resource settings where minimizing complications is essential. This study compares the radiological and functional outcomes of locking compression plates (LCP) and open interlocking intramedullary nails (IMN) in such fractures. Methods: This experimental clinical trial included 36 patients with comminuted femoral shaft fractures, treated with either IMN (n=18) or LCP (n=18). Baseline characteristics, injury profile, surgical details, hospital stay, time to union, radiological outcomes (assessed by the Radiographic Union Score for Tibial fractures [RUST], adapted for femur), and postoperative complications were analyzed. Radiographs were evaluated at 1.5, 3, and 6 months. Results: At 1.5 months, most patients were in the fair RUST category, but by 3 months, half of both groups had achieved good union, and excellent outcomes were more common in the LCP group (33.33% vs. 27.77%). During the 6 months, most patients in both groups achieved good or excellent radiological union, with the LCP group showing a higher proportion of excellent scores (44.44% vs. 33.33%). Functional outcomes for six months also favored LCP, with 44.44% achieving excellent results compared to 33.33% in IMN. Complications were more frequent in the IMN group (11.11% infection, 11.11% non-union), while none were reported in the LCP group. Time to union and hospital stay were comparable between groups. Conclusion: Locking compression plates provide superior radiological healing, fewer complications, and better functional outcomes compared to open interlocking nails in comminuted femoral shaft fractures. These advantages support the use of LCP in resource-limited settings where reliable healing and complication avoidance are essential.