Comparison of Clinical and Radiographic Outcome Between a Single- and Two-Distal Interlocking Screw in Reamed Antegrade Interlocking Intramedullary Nail of Femoral Shaft Fracture: A Retrospective Cohort Study
Keywords:
femoral shaft fracture, intramedullary nail, distal interlocking screw, radiographic union, retrospective cohort studyAbstract
Background and Objective: Intramedullary nailing was used to treat femur shaft fractures. The strength of the nail is obtained by inserting the distal interlocking screw. The objective of this study was to find the union between 1- and 2-distal interlocking screws at 24 weeks.
Methods: This was a retrospective cohort study in 100 patients who were treated with a reamed antegrade intramedullary interlocking nailing at Roi-Et Hospital, during 2017–2023. Data were collected from medical records. Plain radiographs are used to evaluate fracture union using RUST scores and femoral alignment.
Results: Each group of 50 patients there is no statistical difference in age, gender, severity of injury, surgical procedures and types of implant (p>0.05). The 1-screw and 2-screw groups had RUST scores at 24 weeks of 9.7±1.1 and 9.4±1.3 (p=0.242), union rates were 86% and 84% (p=0.779), union times were 19.8±4.9 and 20.7±5.9 weeks (p=0.621). Coronal alignment was 1.6±2.6 and 1.7±2.1 degrees (p=0.899), and sagittal alignment was 4.6±3.9 and 3.5±3.4 degrees (p=0.151). Full weight-bearing walking was achieved at 9.0±4.1 and 9.2±4.5 weeks (p=0.844). Hardware complications was found in only group of the 2-screws, 8% (p=0.117). The cost of implant fixation was 12,380±1,288 and 13,140±1,367 baht (p=0.005).
Conclusion: The 1-distal interlocking screw may have the same result as the 2-distal interlocking screw in terms of fracture union, stable alignment and duration of walking with full weight bearing. There is a lower cost and tends to reduce hardware complications.
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