Assessment of rotational stability with intramedullary interlocking nailing for displaced diaphyseal femoral fractures in adults: A prospective observational study.

Ramesh Ramineni; Mohammad Abdul Akram; Koppula Sreeja

doi:10.51168/sjhrafrica.v7i2.2790

Autori

Ramesh Ramineni Associate Professor, Department of Orthopaedics, Government Medical College, Yadadri Buvanagiri, Telangana
Mohammad Abdul Akram Senior Resident, Department of Orthopaedics, Government Medical College, Yadadri Bhuvanagiri, Telangana, India
Koppula Sreeja Senior Resident, Department of Orthopaedics, Government Medical College, Yadadri Buvanagiri, Telangana

DOI:

https://doi.org/10.51168/sjhrafrica.v7i2.2790

Cuvinte cheie:

Diaphyseal femur fracture, femoral shaft fracture, intramedullary interlocking nail, rotational stability, Thoresen score, fracture union

Rezumat

Background

Diaphyseal femoral fractures are high-energy injuries that require restoration of length, alignment, rotation, and early function. Intramedullary interlocking nailing offers load-sharing fixation and rotational control, particularly in unstable fracture patterns.

Objectives

To assess rotational stability, radiological union, functional recovery, weight-bearing progression, and complications after intramedullary interlocking nailing for displaced diaphyseal femoral fractures in adults.

Methods

This prospective observational study consecutively enrolled 20 adults treated with closed reduction and intramedullary interlocking nailing at the Department of Orthopaedics, Mediciti Institute of Medical Sciences, Ghanpur, Telangana, India. June 2022 to November 2023 represented the recruitment period. Participants were assessed prospectively after surgery for a minimum of 6 months and up to 12 months. Outcomes included alignment, clinical and radiological union, weight-bearing progression, range of motion, pain, swelling, complications, and Thoresen functional criteria.

Results

All 20 enrolled participants completed the minimum follow-up and were analyzed. Males constituted 70.0%, road traffic accidents accounted for 75.0%, and middle-third fractures were the most frequent pattern (45.0%). No participant developed clinically significant rotational deformity greater than 10 degrees, angulation greater than 5 degrees, or shortening greater than 2 cm. Primary union occurred in 18 patients (90.0%). One delayed union required dynamization, and one nonunion required exchange nailing with bone grafting. Excellent Thoresen outcomes were observed in 18 patients (90.0%).

Conclusion

Within the limitations of a small single-centre cohort, intramedullary interlocking nailing provided satisfactory clinical rotational control, maintained alignment, and achieved high union and functional recovery rates in adults with displaced diaphyseal femoral fractures.

Recommendations

Intramedullary interlocking nailing should be performed with careful preoperative planning, accurate fracture-table positioning, appropriate piriformis entry, controlled reduction, sequential reaming, and secure locking. Rotation should be checked repeatedly using cortical width, patellar direction, limb profile, and comparison with the opposite limb.

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