Outcome of femoral fractures treated with cerclages and intramedullary nailing

Abstract Introduction Femoral shaft fractures are a common entity in trauma surgery. The gold standard is closed reduction and intramedullary nailing. However, in some fracture patterns, the surgeon may choose to open the fracture for reduction. The purpose of this retrospective study was to analyze the outcome of femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing. Methods We included adult patients with femoral shaft fractures treated with open reduction, cerclage wiring and intramedullary nailing at a level 1 trauma center in Switzerland during an 11-year period. The data collection was conducted retrospectively. Patient characteristics including age, sex and existing comorbidities were analyzed. Detailed information regarding the fracture patterns and surgical procedures was recorded. Outcome measures included the rates of malunion and nonunion, the time required for union, incidence of surgical site infections, and the frequency of revision surgeries. Results We included a total of 69 patients, comprising 48 males and 21 females with a mean age of 50 years. A majority suffered a high velocity trauma (67%). The most common fracture type was multifragmentary subtrochanteric fracture. Approximately 57% of the patients underwent definitive surgical care within the first 24 h. Number of cerclages applied ranged from 1 to 4, with 18% positioned above the lesser trochanter. Delayed union occurred in 10% of cases, while nonunion was noted in 19% of patients. Complications included femoral head necrosis in 3 (4%) patients, and surgical site infections were documented in 3 (4%) cases. Conclusion Our findings give rise to closed reduction and internal fixation as a treatment of choice of femoral shaft fractures. We suggest the use of ORIF combined with cerclages, if closed reduction cannot be sufficiently achieved. However, a risk–benefit ratio should be assessed to minimize the risk of a higher complication rate with the use of ORIF.