Background: Femoral shaft fractures are among the most common orthopedic injuries, and improper management may result in severe disability or even death. Although intramedullary nailing (IMN) is considered the gold standard, plate fixation is preferred in pathological fractures or malunion cases. This study aimed to compare the clinical and radiographic outcomes of single-plate (SP) versus double-plate (DP) fixation in patients treated at Fatemi Hospital, Ardabil, during 2023–2024.
Methods: This retrospective cohort study included 40 patients (20 in the DP group and 20 in the SP group). Evaluated variables included clinical and radiographic union times, pain scores based on the Visual Analogue Scale (VAS), functional outcomes measured by the Lower Extremity Functional Scale (LEFS), time to start weight-bearing, and complication rates (infection, nonunion, and implant failure). Data were analyzed using independent samples t-test, Chi-square, and Fisher's exact test, with a significance level set at P < 0.05.
Findings: The DP group demonstrated a significantly shorter clinical union time (17.9 weeks vs. 21.6 weeks, P = 0.011). Radiographic union time was also significantly shorter in the DP group compared to the SP group (19.7 weeks vs. 24.3 weeks, P = 0.008). Patients in the DP group achieved significantly higher LEFS scores (77 vs. 68, P = 0.016) and were able to initiate weight-bearing earlier (8.8 weeks vs. 11.4 weeks, P = 0.019). The infection rate was higher in the DP group (20% vs. 5%); however, this difference was not statistically significant (P = 0.29). Implant failure occurred exclusively in the SP group (15%, P = 0.037). Additionally, the frequency of residual pain was higher in the DP group (30% vs. 10%), approaching statistical significance (P = 0.09).
Conclusion: The double-plate system provides superior mechanical stability and is associated with improved clinical outcomes. Therefore, it may be considered the preferred option for fixation of femoral shaft fractures, particularly in cases requiring long-term stabilization.