Journal of Isfahan Medical School

Journal of Isfahan Medical School

Comparison of Clinical Outcomes of Double-Plate and Single-Plate Fixation in Femoral Shaft Fractures

Document Type : Original Article(s)

Authors
Shahriyar Khoshbakht 1
Omid Rasti 2
Milad Hajiabadi 3
1 Assistant Professor, Department of Orthopedic, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
2 Assistant Professor, Department of Orthopedic, Faculty of Medicine, Sarab University of Medical Sciences, Sarab, Iran
3 Demartment of Orthopedic, Faculity of Medicine, Ardabil University of Medical Scinenes, Ardabil, Iran
10.48305/jims.v44.i862.0751
Abstract
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.

Highlights

Shahriyar Khoshbakht: Google Scholar

Omid Rasti: PubMed

Keywords
Femoral Fractures
Bone Plates
Fracture Healing
Infection
Implant Failure
Subjects
1.     Nork SE. Fractures of the shaft of the femur. In: Bucholz RW, Heckman JD, Court-Brown CH, eds. Rockwood and Green's fractures in adults. 7th ed. Philadelphia: Lippincott, Williams & Wilkins; 2010. p 1655-710.
2.     Benirschke SK, Melder I, Henley MB, Routt ML, Smith DG, Chapman JR, et al. Closed interlocking nailing of femoral shaft fractures: assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review. J Orthop Trauma 1993; 7(2): 118-22.
3.     Madey SM, Tsai S, Fitzpatrick DC, Earley K, Lutsch M, Bottlang M. Dynamic fixation of humeral shaft fractures using active locking plates: a prospective observational study. Iowa Orthop J 2017; 37: 1-10.
4.     Paige Whittle A. Fractures of the lower extremity. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia: Mosby; 2008. p 2811-921.
5.     Stoffel K, Sommer C, Lee M, Zhu TY, Schwieger K, Finkemeier C. Double fixation for complex distal femoral fractures. EFORT Open Rev 2022; 7(4): 274-86.
6.     El Beaino M, Morris RP, Lindsey RW, Gugala Z. Biomechanical Evaluation of Dual Plate Configurations for Femoral Shaft Fracture Fixation Biomed Res Int 2019; 2019: 5958631.
7.     Maoerl F, Wyss A, Brunner CH, Binder W. Plate osteosynthesis of femoral shaft fractures in adults: a follow-up study. Clin Orthop Relat Res 1979; 138: 62-73.
8.     Al-Ahmad A, Wiedmann-Al-Ahmad M, Fackler A, Follo M, Hellwig E, Bächle M, et al. In vivo study of the initial bacterial adhesion on different implant materials. Arch Oral Biol 2013; 58(9): 1139-47.
9.     Marsell R, Einhorn TA. The biology of fracture healing. Injury 2011; 42(6): 551-5.
10.  Boutros M, Awad G, Asmar C, Lawand J, Mouawad A, Saidy E. Locking compression plate fixation versus intramedullary nailing for subtrochanteric femoral fractures: a meta-analysis. Hip Int 2026; 36(2): 336-46.
11.  Motififard M, Mousavi H, Iranpanah N, Aghdam HA, Teimouri M, Aliakbari M, et al. Comparative study of exchange nailing and augmentative plating for treating aseptic nonunion of femoral shafts post intramedullary nailing: A single-blind, multicentric randomized clinical trial. J Clin Med 2024; 13(22): 6928.
12.  Kriechling P, Bowley AL, Ross LA, Moran M, Scott CE. Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty. Bone Jt Open 2024; 5(6): 489-98.
Song M, Wen J, Wang Z, Zeng Y, Lu J, Lu W, et al. Experimental study on the biomechanical loading of a four-dimensional plate for the fixation of femoral shaft fractures. BMC Musculoskelet Disord 2025; 26(1): 535
Journal of Isfahan Medical School
Volume 44, Issue 862
2nd Week, July
July and August 2026
Pages 751-757

  • Receive Date 21 June 2026
  • Accept Date 12 July 2026