Intramedullary Nailing for the Treatment of Femoral Shaft Fractures in Adults: A Systematic Review of Union and Functional Outcomes

Abstract

Introduction: Femoral shaft fractures are severe injuries commonly resulting from high-energy trauma. Antegrade intramedullary nailing has become the gold standard for treatment. This systematic review synthesizes the extensive evidence on the efficacy and outcomes of this procedure.

Methods: A systematic search of prospective and retrospective cohort studies was conducted. We included studies of adult patients with traumatic femoral shaft fractures treated with antegrade intramedullary nailing. The primary outcomes were the rate of fracture union, time to union, and incidence of major complications such as infection and nonunion.

Results: The analysis of over 100 studies, encompassing thousands of patients, demonstrated a consistently high rate of fracture union, typically exceeding 95-98%. The time to full weight-bearing was rapid, and functional outcomes were generally excellent. The most common complications included malrotation and hip or knee pain related to nail insertion, but rates of deep infection and nonunion were low.

Discussion: Intramedullary nailing provides stable internal fixation that allows for early mobilization, which is crucial for preventing the complications of prolonged immobilization. The procedure's high success rate has solidified its role as the treatment of choice for most femoral shaft fractures in adults.

Conclusion: Intramedullary nailing is a highly effective and reliable treatment for adult femoral shaft fractures, resulting in excellent union rates and functional outcomes.