Reduction of butterfly fragments in femur fractures: a comparative analysis

Purpose This study compares the outcomes, 6 months postoperative, of femoral fracture interventions featuring nondisplaced and displaced butterfly fragments. The progress of healing, presence or absence of cortical defects, pain score after 6 months, and necessity of revision surgery are measured. Materials and methods This is a retrospective cohort study reviewing 100 patients with butterfly femur fractures treated with an intramedullary nail at King Fahad Hospital Hofuf. The patients were divided into two groups: one, of 48 patients, with displaced butterfly fragments after surgery and a second group of 52 patients with nondisplaced butterfly fragments, and all butterfly fragment was not fixed by any method, none of the fragment approximated by close or open reduction methods. Result In the first group, 38 patients (79.2%) showed delayed union 6 months after surgery, 30 (62.5%) had a cortical defect, 6 (12.5%) required revision surgery, and 42 (87.5%) still reported feeling pain. In the second group, 8 patients (15.4%) showed delayed union, none had cortical defects, 4 (07.7%) required revision surgery, and 10 (19.2%) reported pain 6 months after surgery. Conclusion Displaced butterfly fragments should be reduced to near-anatomical alignment to prevent delayed union, cortical defects, and pain.