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Purpose <p>This study compared patient-reported functional outcomes, range of motion, and radiological alignment in antegrade (AN) versus retrograde nailing (RN) for midshaft femur fractures (AO/OTA type 32).</p> Methods <p>A retrospective review of adult patients treated between January 1, 2001, and May 1, 2016, was conducted. Patients completed questionnaires and underwent physical exams to measure leg length, rotation, and hip/knee range of motion. Final radiographs assessed union alignment.</p> Results <p>A total of 162 patients with 173 fractures were included, with a median follow-up of 8.2 years. Of the 52 patients completing full follow-up, 8% showed rotational malalignment with a flexed hip, and 6% had &gt; 15° malalignment with an extended hip. Knee flexion-extension range was slightly better in the AN group (130° vs. 125°; <i>p</i> = 0.019). Patients treated with AN also showed better results in the Lower Extremity Functional Scale (LKS) (83 vs. 61; <i>p</i> = 0.041) and the SMFA dysfunction index (13 vs. 29; <i>p</i> = 0.026) compared to RN.</p> Conclusion <p>While both nailing techniques produced similar overall outcomes, AN demonstrated fewer complications, fewer rotational issues, and better patient-reported outcomes. Based on these findings, AN is preferred over RN for treating midshaft femoral fractures when technically feasible.</p>

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Long-term outcome after middle third fractures of the femur shaft; a comparison between antegrade and retrograde nailing

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月28日

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  • J. Daniël Cnossen,
  • Esther M. M. Van Lieshout,
  • Michael H. J. Verhofstad

摘要

Purpose

This study compared patient-reported functional outcomes, range of motion, and radiological alignment in antegrade (AN) versus retrograde nailing (RN) for midshaft femur fractures (AO/OTA type 32).

Methods

A retrospective review of adult patients treated between January 1, 2001, and May 1, 2016, was conducted. Patients completed questionnaires and underwent physical exams to measure leg length, rotation, and hip/knee range of motion. Final radiographs assessed union alignment.

Results

A total of 162 patients with 173 fractures were included, with a median follow-up of 8.2 years. Of the 52 patients completing full follow-up, 8% showed rotational malalignment with a flexed hip, and 6% had > 15° malalignment with an extended hip. Knee flexion-extension range was slightly better in the AN group (130° vs. 125°; p = 0.019). Patients treated with AN also showed better results in the Lower Extremity Functional Scale (LKS) (83 vs. 61; p = 0.041) and the SMFA dysfunction index (13 vs. 29; p = 0.026) compared to RN.

Conclusion

While both nailing techniques produced similar overall outcomes, AN demonstrated fewer complications, fewer rotational issues, and better patient-reported outcomes. Based on these findings, AN is preferred over RN for treating midshaft femoral fractures when technically feasible.