Dual Fixation in Complex Long Bone Fractures: A Case Series of 30 Patients

Complex long bone fractures characterized by comminution, segmental patterns, metaphyseal extension, or associated joint instability pose significant challenges to stable fixation. While intramedullary nailing remains the standard treatment for diaphyseal fractures, certain fracture configurations are prone to mechanical failure, delayed union, or non-union when treated with a single fixation modality. Dual fixation using a combination of intramedullary nailing and plate augmentation may provide superior biomechanical stability and improve healing outcomes.

To evaluate the clinical and radiological outcomes of primary dual fixation in complex long bone fractures and to assess its role as a proactive strategy for preventing fixation failure and non-union.

A prospective case series was conducted at a tertiary care center over a 24-month period. Thirty adult patients (24 males, 6 females; mean age 36.9 years) with complex long bone fractures were treated using primary dual fixation consisting of a non-locking intramedullary nail supplemented with plate augmentation. Fracture locations included the femur (n = 14), humerus (n = 14), and ulna (n = 2). Patients were followed for a minimum of 12 months. Outcome measures included radiological union, functional scores using the Disabilities of the Arm, Shoulder, and Hand (DASH) and lower extremity functional scale (LEFS), time to mobilization, and complications.

Union was achieved in all 30 patients (100%). Mean time to radiological union was 16.5 weeks (range 13-22 weeks). Delayed union occurred in 3 patients (10%) but resolved without additional intervention by 24 weeks. No cases of non-union or construct failure were observed. Mean DASH score for upper-limb fractures was 12.8, while the mean LEFS score for lower-limb fractures was 75.6. Excellent-to-good functional outcomes were achieved in 26 patients (86.7%). Partial weight-bearing commenced at a mean of 4.5 weeks, and full weight-bearing was achieved at a mean of 10.8 weeks in lower-limb fractures. Complications included superficial infection in 2 patients (6.7%), implant irritation in 3 patients (10%), and migration of a titanium elastic nail in 2 patients (6.7%). No deep infections occurred.

Primary dual fixation provides reliable union, excellent functional outcomes, and a low complication rate in complex long bone fractures. By combining the load-sharing advantages of intramedullary nailing with the rotational and axial stability of plate augmentation, this strategy may prevent the delayed union, non-union, and fixation failures traditionally associated with mechanically unstable fracture patterns. These findings support consideration of dual fixation as a definitive primary treatment option in selected complex fractures and warrant further evaluation through prospective comparative studies.