Comparison of Outcome of Femoral Shaft Fracture Fixation with Intramedullary Nail in Elderly Patient and Patients Younger than 60 Years Old

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Background:   Although intramedullary nailing (IMN) is an established and accepted operative treatment for femoral shaft fracture in patients younger than 60, there is a lack of data on the results of this treatment on those over 60. The purpose of this study was to determine if the outcome of IMN for femoral shaft fracture in elderly patients is also acceptable. Particular challenges in this group of patients included osteopenia and other associated multiple medical problems frequently observed. Methods: The outcome of 84 patients who had IMN for femoral shaft fracture was reviewed and the results were compared between two groups of patients (younger than 60 and over 60 year old patients). Complications and mortality was analyzed for each group, and then compared between the two groups by testing the null hypothesis that the outcome of treatment in the two groups are similar (P>0.05). Results: The mean duration of follow up was 57.3 months (range: 10-94 months). Incidence of malunion, nonunion, infection, DVT, and dependence on walker/crutch in the groups were similar and differences were not significant (P>0.05). However, incidence of mortality (P<0.05), knee pain, loss of motion, and dependence on cane were significantly higher in elderly patients (P<0.05). Conclusions: There is no significant difference between the outcomes of femoral shaft fracture treatment with IMN fixation in younger patients when compared with elderly patients. However, elderly patients with IMN have more symptoms when compared with younger patients.