Comparative analysis of adolescent intramedullary nailing and locking plate fixation for femoral shaft fractures.

BACKGROUND: Femoral shaft fractures in adolescents are commonly treated with either antegrade intramedullary nailing (AIN) or lateral plate (LP) fixation. This study compared the clinical outcomes of these two methods. METHODS: Adolescent patients with femoral shaft fractures were randomly assigned to either the AIN group (n = 62) or the LP group (n = 62). Surgical parameters, early recovery metrics, levels of inflammatory cytokines, pain mediators, and bone metabolism markers were assessed. RESULTS: The AIN group had significantly shorter incision lengths (6.8 vs. 8.5†cm, p < 0.001) and lower intraoperative blood loss (120 vs. 170†ml, p < 0.001) compared to the LP group. AIN patients began weight-bearing activities earlier (34 vs. 47 days, p < 0.01). Three months post-operation, the AIN group showed superior proximal femoral geometry and hip function, with a higher non-arthritic hip score (NAHS, 87 vs. 75, p < 0.001). One-week post-operation, the AIN group had lower serum levels of inflammatory cytokines and pain mediators, indicating a reduced inflammatory response and less postoperative pain. CONCLUSIONS: AIN offers significant advantages over LP in treating adolescent femoral shaft fractures, including reduced surgical trauma, faster early recovery, lower inflammatory response, less postoperative pain, and enhanced bone healing.