Limited open reduction versus closed reduction in retrograde nailing for mid-distal femoral fractures

To compare the clinical outcomes of limited open reduction versus closed reduction in retrograde intramedullary nailing for mid-distal femoral shaft fractures.

A retrospective analysis was conducted on 107 patients with isolated mid-distal femoral shaft fractures treated with retrograde intramedullary nailing between January 2016 and May 2024. Patients were divided into two groups: limited open reduction (61 cases) and closed reduction (46 cases). The two groups were compared in terms of the number of intraoperative fluoroscopies, operative time, intraoperative blood loss, the number of cases requiring open reduction due to failed reduction, postoperative VAS scores, and/or incision-related complications. During a follow-up period of 9-36 months, HSS functional scores and postoperative nonunion rates were evaluated to assess efficacy.

The limited open reduction group showed statistically significant advantages over the closed reduction group in the following metrics: the number of intraoperative fluoroscopies (9.33 vs. 12.24 times, p = 0.001), operative time (92.61 vs. 108.65 min, p = 0.018), intraoperative blood loss (209.18 vs. 237.83 mL, p = 0.001), the number of cases requiring open reduction (5 vs. 12 cases, p = 0.012), and postoperative nonunion rate (2 vs. 5 cases, p = 0.034). No statistically significant differences were observed between the two groups in early incision-related complications (3 vs. 6 cases, p = 0.772), postoperative VAS scores (3.44 vs. 3.55, p = 0.820), or HSS knee function scores 6 months postoperatively (92.72 vs. 92.31, p = 0.674).

Compared with closed reduction, limited open reduction at the fracture plane in retrograde intramedullary nailing for mid-distal femoral shaft fractures offers significant advantages: it facilitates rapid insertion of the long guidewire, reduces the number of fluoroscopies, shortens operative time, decreases intraoperative blood loss, and minimizes intraoperative changes in the surgical strategy. Importantly, the limited open reduction does not increase incision-related complications or pain and does not affect knee joint function.