Comparison of Locking Plate versus Intramedullary Nailing in Diaphyseal Long-Bone Fractures: A Prospective Study

Open Access

Abstract

Background: Diaphyseal long-bone fractures are a common presentation in orthopedic trauma, and the optimal treatment between locking plate fixation and intramedullary nailing is still under debate. This study aimed to evaluate and compare the results of operative, radiological, and functional outcomes between locking plate fixation and intramedullary nailing for diaphyseal long-bone fractures. Methods & Materials: This prospective comparative study was carried out at the Department of Orthopaedics, Cox's Bazar Medical College & Hospital, Cox's Bazar, Bangladesh from January 2026 to June 2026 on 80 patients with diaphyseal fractures of the femur, tibia, and humerus who were divided randomly into two groups: Group A: 40 patients treated with locking plate fixation, and Group B: 40 patients treated with intramedullary nailing. The demographic, perioperative, radiological, and functional parameters were recorded and compared using an independent t-test and Chi-square/Fisher's exact test on SPSS version 26. A p<0.05 was considered significant. Results: Baseline demographics were similar among the groups. Plating was related to more operative time and more blood loss, while nailing was related to more fluoroscopy exposure. Radiological union was significantly faster with nailing (16.4±3.1 versus 18.2±3.8 weeks; p=0.028), and Lower Extremity Functional Scale scores were significantly higher at 6 months (75.8±4.9 versus 72.3±5.8; p=0.005). Rates of implant irritation were higher with plating. Joint stiffness and anterior knee pain were more frequent with nailing. Overall complication rates were similar. Conclusion: Intramedullary nailing leads to an earlier union and earlier functional recovery than locking plate fixation for diaphyseal long-bone fractures. Both techniques have distinct but comparable complication profiles, and individualized implant selection based on fracture and patient factors is justified.