Segmental femoral fracture management using intramedullary nailing combined with plate fixation: a case report

Segmental femoral fractures are challenging, with a high risk of non-union, requiring tailored treatments such as intramedullary nailing (IMN) and plate fixation. Although this combined approach is promising for tibial fractures, its effectiveness in segmental femoral fractures remains under evaluation. This study aims to evaluate the success rates of IMN and plate fixation in treating these challenging injuries.

A 52-year-old man presented with a deformed, shortened left thigh, moderate tenderness (Visual Analogue Scale score of 4), and limited hip and knee mobility; ankle and toe movements were normal. X-rays showed a comminuted femur fracture with posteromedial translation. He received skeletal traction followed by open reduction and internal fixation with an intramedullary nail, proximal femur C-wire, and distal femur bridging plate.

Adult femoral shaft fractures are typically managed with closed reduction and IMN, though non-union is a concern, especially in type C and segmental fractures. Adding a unicortical plate before IMN can simplify these complex cases and improve outcomes.

Combining IMN with bridge plating stabilizes severe segmental femoral fractures and aids healing. Progressive rehabilitation after surgery supports physical and functional recovery, allowing tailored strategies based on fracture type and patient needs. This case adds to the limited clinical evidence supporting this method and may assist surgeons in treating similarly challenging fracture patterns.