AUTHOR=Li Qingwei , Wang Jianqiang , Sun Chunyan , Lu Lintao , Mu Zongyou , Zhang Xubin 

TITLE=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

JOURNAL=Frontiers in Surgery

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2025.1550063

DOI=10.3389/fsurg.2025.1550063

ISSN=2296-875X

ABSTRACT=BackgroundIntramedullary 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.MethodsThis 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.ResultsThe 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 Small-incision-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).ConclusionsSmall-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 multi-centre studies are needed for broader validation.