BRIEF RESEARCH REPORT article
Front. Surg.
Sec. Orthopedic Surgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1550063
Clinical Outcomes of Closed Reduction vs Small-Incision-Assisted Open Reduction with Intramedullary Nailing in Complex Comminuted Femoral Shaft Fractures (AO/OTA 32-C): A Retrospective Cohort Study
Provisionally accepted
- 1School of Clinical Medicine, Shandong Second Medical University, Weifang, China
- 2Department of Orthopedic, Qilu Hospital Dezhou Hospital of Shandong University, Dezhou, China
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Intramedullary nailing (IMN) is the preferred treatment owing to its minimally invasive nature, high healing rates, and reduced stress shielding. However, the optimal reduction method for complex comminuted fractures (AO/OTA 32-C) has been controversial. Closed reduction preserves blood supply but requires extensive fluoroscopy and technical expertise. Small-incision-assisted open reduction enhances visualisation and facilitates reduction but entails slightly increased soft tissue exposure. This retrospective cohort study analysed 70 patients with AO/OTA 32-C femoral shaft fractures treated with intramedullary nailing. Patients were categorised into a Closed reduction group (n = 35) and Small-incision-assisted open reduction group (n = 35). Outcomes assessed included operative time, fluoroscopy usage, blood loss, infection rates, hospital stay duration, and functional outcomes at 3, 6, and 12 months postoperatively.The Small-incision-assisted open reduction group had shorter operative times (45.09 ± 5.67 vs 78.34 ± 5.71 min, P < 0.05) and lower fluoroscopy usage (6.03 ± 1.51 vs 22.33 ± 5.99, P < 0.05). While blood loss and incision length were higher, infection rates and hospital stays were comparable between the groups. Functional outcomes at 3 and 6 months were significantly better in the Smallincision-assisted open reduction group, with no differences at 12 months. The Small-incision-assisted open reduction group also had a higher excellent-to-good fracture healing rate (88.6% vs 60.0%, P < 0.05).Small-incision-assisted open reduction reduces operative time, fluoroscopy usage, and improves early functional outcomes. It is a safe and efficient alternative to closed reduction, but larger multicentre studies are needed for broader validation.
Keywords: femoral shaft fracture1, intramedullary nailing2, closed reduction3, small-incisionassisted open reduction4, AO/OTA 32-C5, fracture healing6, surgical outcomes7
Received: 22 Dec 2024; Accepted: 07 May 2025.
Copyright: © 2025 Li, Wang, Sun, Lu, Mu and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xubin Zhang, Department of Orthopedic, Qilu Hospital Dezhou Hospital of Shandong University, Dezhou, China
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