Osteosynthesis of femoral shaft fractures at Brazzaville University Hospital: Nail versus screw plate

Introduction: Fractures of the femoral shaft are serious traumatic conditions frequently encountered in hospital. The aim of our study was to compare two different surgical techniques for their treatment: anterograde centromedullary nail and compression plate. Materials and Methods: From September 2018 to August 2023, 208 femoral shaft fractures were recorded out of 3236 hospitalizations, i.e. 6.42%. Two groups of patients were selected: group 1 with 122 patients treated with anterograde nails and group 2 with 49 patients treated with screw plates. These two groups were compared according to fracture type (AO/OTA), time to surgery, follow-up and consolidation, and complications. Data were processed in Excel and SPSS 19.0 with significant p-value when less than or equal to 0.05. Results: The time to surgery was 29.11±1.13 days for group 1 and 27.74±2.41 days for group 2 (p=0.0005). Most of the patients were treated in the middle third (78.68% in group 1 and 65.3% in group 2). Bone consolidation was achieved at 4.91±0.52 months for group 1 and 5.72±0.34 months for group 2 (p=0.000007). The main complication was limb length inequality in 6 cases (4.92%) in group 1 and 9 cases (18.36%) in group 2. Discussion: Although our study was monocentric, it was carried out in the largest hospital in the country. The middle third was the most frequent site for us, as it was for most authors. This is the area most exposed to high-energy trauma and torsional forces. Complications are due to delayed surgery and unfavourable operating conditions. Conclusion: Comparing the two main surgical techniques, the results are better for the anterograde femoral centromedullary nail. The choice of implant depends on the type of fracture, the surgeon's habits and the implants available.