A Prospective Study of Functional and Radiological Outcomes of Femoral Shaft Fractures Managed with Intramedullary Interlocking Nail

Background: Femoral shaft fractures commonly result from high-velocity road traffic accidents. Intramedullary interlocking nailing is the preferred treatment due to its stability, minimal soft tissue damage, and early mobilization. This prospective study evaluates the functional and radiological outcomes of intramedullary interlocking nailing in adult femoral shaft fractures at a tertiary care center. Material and Methods: Over one year, 50 consecutive adult patients (aged 18-65 years) with acute femoral shaft fractures (AO/OTA 32-A, B, C) were enrolled after ethical approval. Inclusion criteria encompassed closed or Gustilo grade I/II open fractures within 72 hours of injury. Exclusions included pathological fractures, polytrauma with ISS >18, or prior ipsilateral femur surgery. All underwent antegrade IMILN under spinal anesthesia using stainless steel nails (size 9-12 mm) with proximal and distal locking. Postoperative protocol included partial weight-bearing at 2 weeks, advancing to full by 6-8 weeks. Follow-up assessments at 6 weeks, 3, 6, and 12 months involved radiological union (bridging callus in three cortices), alignment (varus/valgus <5°, rotation <10°), and functional scoring via Thoresen criteria. Data analysis used SPSS v26. Results: Mean age was 35.2±12.4 years; 80% male. Road traffic accidents caused 72% injuries. Fractures: 60% transverse (32-A3), 40% oblique/comminuted. Mean operative time: 68±15 min; blood loss: 180±45 ml. Union achieved in 94% by 6 months (mean 15.2±3.8 weeks). Excellent functional outcomes in 70%, good 20%, fair 8%, poor 2%. Complications: superficial infection 4%, malunion 6%, delayed union 8%. Knee ROM averaged 120°±10° at 12 months; no implant failures. Conclusion: IMILN yields high union rates and favorable functional recovery in femoral shaft fractures, with low complications in a resource-constrained setting. Early intervention and meticulous technique are pivotal for optimal outcomes, supporting its routine use in Indian trauma centers.