Faculty mentor/PI email address
abedin@rowan.edu
Keywords
Orthopedics, Femur Fractures, Intramedullary Nailing, Union Rate
Date of Presentation
5-6-2026 12:00 AM
Poster Abstract
Background:
Antegrade and retrograde intramedullary nailing are widely used for femoral fractures, yet their relative advantages across fracture locations remain debated. This study compares union rates, time to union, malunion, and functional outcomes between approaches, stratified by AO/OTA classification.
Methods:
A systematic review of PubMed, Embase, Cochrane Library, Web of Science, and Scopus (2015 to 2025) was performed. Studies reporting outcomes of antegrade and/or retrograde nailing for proximal (31), diaphyseal (32), and distal (33) femoral fractures were included. Data on demographics, fracture classification, fixation method, and outcomes were extracted. Risk of bias was assessed using ROBINS-I. Pooled estimates were calculated using random-effects models with subgroup analysis by fracture location.
Results:
Thirty-nine studies (N = 2392) met inclusion criteria. In diaphyseal fractures (AO 32), union rates were comparable between antegrade and retrograde nailing (82.7% vs 85.1%), with similar time to union (20.2 vs 20.0 weeks). Malunion rates were higher in the antegrade group (11.6% vs 6.3%), though differences were not statistically significant. In proximal fractures (AO 31), antegrade nailing demonstrated higher union rates (95.5% vs 76.9%), although retrograde data were limited. In distal fractures (AO 33), retrograde nailing predominated, with union rates of 88.7%, while antegrade data were limited but demonstrated 100% union in a single study.
Conclusions:
Antegrade and retrograde nailing demonstrate equivalent outcomes for femoral shaft fractures. Evidence for proximal and distal fractures remains limited and asymmetric. Surgical approach should be individualized, with further prospective studies needed to define optimal strategies across fracture subtypes.
Disciplines
Medicine and Health Sciences | Musculoskeletal System | Wounds and Injuries
Comparative Analysis of Antegrade and Retrograde Nailing for Proximal, Shaft, and Distal Femur Fractures
Background:
Antegrade and retrograde intramedullary nailing are widely used for femoral fractures, yet their relative advantages across fracture locations remain debated. This study compares union rates, time to union, malunion, and functional outcomes between approaches, stratified by AO/OTA classification.
Methods:
A systematic review of PubMed, Embase, Cochrane Library, Web of Science, and Scopus (2015 to 2025) was performed. Studies reporting outcomes of antegrade and/or retrograde nailing for proximal (31), diaphyseal (32), and distal (33) femoral fractures were included. Data on demographics, fracture classification, fixation method, and outcomes were extracted. Risk of bias was assessed using ROBINS-I. Pooled estimates were calculated using random-effects models with subgroup analysis by fracture location.
Results:
Thirty-nine studies (N = 2392) met inclusion criteria. In diaphyseal fractures (AO 32), union rates were comparable between antegrade and retrograde nailing (82.7% vs 85.1%), with similar time to union (20.2 vs 20.0 weeks). Malunion rates were higher in the antegrade group (11.6% vs 6.3%), though differences were not statistically significant. In proximal fractures (AO 31), antegrade nailing demonstrated higher union rates (95.5% vs 76.9%), although retrograde data were limited. In distal fractures (AO 33), retrograde nailing predominated, with union rates of 88.7%, while antegrade data were limited but demonstrated 100% union in a single study.
Conclusions:
Antegrade and retrograde nailing demonstrate equivalent outcomes for femoral shaft fractures. Evidence for proximal and distal fractures remains limited and asymmetric. Surgical approach should be individualized, with further prospective studies needed to define optimal strategies across fracture subtypes.