Incidence of Local Complications after Intramedullary Nailing and after Plate Fixation of Femoral Shaft Fractures

A consecutive series of 378 patients with 381 acute adult femoral shaft fractures in previously intact femora admitted during a 10-year period was reviewed for the incidence of local complications including malunion. The majority, 282 fractures (74%), were caused by motor vehicle accidents. The median age of the patients was 28 years. The policy of management was internal fixation of the fracture on the day of admission. The method of treatment was intramedullary nailing (Küntscher or interlocking nailing) in 279 and plate fixation in 102 fractures. A local complication occurred in 90 patients (24%). Of these 90 cases 24 had malunion only while in the remaining 66 patients there was mechanical failure of fixation in 27, local infection in 20 (5.3% of the total), delayed union or nonunion in 15, and refracture in four patients. Concurrent injuries in the lower extremities were associated with a significantly increased frequency of delayed union, nonunion, and refracture. In 41 patients (11%) a total of 58 reoperations had to be undertaken because of local complications. There was an over-representation of plated fractures among those patients suffering a local complication classified as severe, 24 out of 37 (chi 2 = 30.3; p less than 0.001). Consequently, we now only exceptionally use plate fixation in the management of femoral shaft fractures.