Comparative Analysis of Outcomes of Intramedullary Nailing Versus Plate Fixation for Femoral Shaft Fractures in Adults: A Multicentre Study in Southwest Nigeria

The optimal surgical management of femoral shaft fractures in adults remains a subject of ongoing debate, particularly in resource-limited settings where implant availability, imaging infrastructure, and surgical expertise vary widely. This multicentre retrospective cohort study compares the outcomes of intramedullary nailing (IMN) and plate fixation for femoral shaft fractures in adults across three tertiary hospitals in South West Nigeria, namely Lagos University Teaching Hospital, Obafemi Awolowo University Teaching Hospital, and University College Hospital, Ibadan. Over a five-year review period, case records of all adult patients with isolated femoral shaft fractures treated surgically will be reviewed. Primary outcomes assessed include time to radiological union, malunion and non-union rates, implant failure, infection, and functional outcome at twelve months using the Lower Extremity Functional Scale (LEFS). Secondary outcomes include operative time, intra-operative blood loss, and length of hospital stay. Multivariable logistic regression will control for fracture classification (AO/OTA), patient age, and timing of surgery. The study hypothesises that IMN is associated with superior functional outcomes and fewer complications across all AO fracture types in this population. Findings will contribute to the development of evidence-based South West Nigerian protocols for femoral fracture management and support informed implant procurement decisions. Keywords: femoral shaft fractures, intramedullary nailing, plate fixation, LEFS, multicentre study.