Comparative Study of Intramedullary Nailing Vs. Plating in Long Bone Fractures

Abstract

Introduction: Long bone fractures are among the most common orthopedic injuries and require stable fixation for optimal functional recovery. Two widely practiced internal fixation methods are intramedullary (IM) nailing and plating. While IM nailing offers the advantages of load sharing, preservation of periosteal blood supply, and early mobilization, plating provides direct fracture visualization, anatomic reduction, and rigid fixation. The choice of method remains a matter of debate, particularly with regard to union rates, complications, and functional outcomes. Methods: This study was a prospective comparative observational study conducted in the Department of Orthopaedics at Burdwan Medical College & Hospital from July 2024 to July 2025. A total of 70 adult patients with diaphyseal fractures of the femur, tibia, humerus, or forearm were enrolled and divided equally into two groups: intramedullary nailing and plating. Data were collected on patient demographics (age and gender), fracture characteristics (site), intraoperative parameters (mean operative time, mean blood loss, and fluoroscopy time), postoperative outcomes including complications, and patient satisfaction. All patients were managed according to standard surgical protocols, and follow-up was conducted to assess fracture union, functional recovery, and overall satisfaction. Results: In this study of 70 patients with long bone fractures (35 IM nailing, 35 plating), baseline demographics and fracture characteristics were comparable. IM nailing showed shorter operative time (72.3 ± 15.6 vs. 98.7 ± 18.2 min, p <0.001), lower blood loss (120 ± 40 vs. 250 ° 60 ml, p <0.001), but higher fluoroscopy time (95 ° 25 vs. 60 ± 20 sec, p <0.001). Fracture union occurred earlier (16.5 ± 3.2 vs. 18.2 ± 3.5 weeks, p = 0.03), with similar rates of nonunion and malunion. Complications were low and comparable. Functional outcomes favored IM nailing, with lower DASH scores (12.5 ± 4.3 vs. 14.8 ± 5.1, p = 0.04) and earlier full weight bearing (14.1 ± 2.5 vs. 15.6 ± 3.0 weeks, p = 0.02). Patient satisfaction was high in both groups. Conclusion: Both intramedullary nailing and plating are effective methods of fixation for long bone fractures. Intramedullary nailing has advantages in terms of less operative morbidity, faster union, and earlier mobilization, making it more suitable for lower limb fractures. Plating remains valuable where precise anatomic reduction is required, especially in forearm fractures. An individualized approach considering fracture pattern, bone involved, and patient factors should guide the choice of fixation method.