{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:34:36Z","timestamp":1753893276656,"version":"3.41.2"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Intramedullary nailing (IMN) is the preferred treatment owing to its minimally invasive nature, high healing rates, and reduced stress shielding. However, the optimal reduction method for complex comminuted fractures (AO\/OTA 32-C) has been controversial. Closed reduction preserves blood supply but requires extensive fluoroscopy and technical expertise. Small-incision-assisted open reduction enhances visualisation and facilitates reduction but entails slightly increased soft tissue exposure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective cohort study analysed 70 patients with AO\/OTA 32-C femoral shaft fractures treated with intramedullary nailing. Patients were categorised into a Closed reduction group (<jats:italic>n<\/jats:italic>\u2009=\u200935) and Small-incision-assisted open reduction group (<jats:italic>n<\/jats:italic>\u2009=\u200935). Outcomes assessed included operative time, fluoroscopy usage, blood loss, infection rates, hospital stay duration, and functional outcomes at 3, 6, and 12 months postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The Small-incision-assisted open reduction group had shorter operative times (45.09\u2009\u00b1\u20095.67 vs. 78.34\u2009\u00b1\u20095.71\u2005min, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05) and lower fluoroscopy usage (6.03\u2009\u00b1\u20091.51 vs. 22.33\u2009\u00b1\u20095.99, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05). While blood loss and incision length were higher, infection rates and hospital stays were comparable between the groups. Functional outcomes at 3 and 6 months were significantly better in the Small-incision-assisted open reduction group, with no differences at 12 months. The Small-incision-assisted open reduction group also had a higher excellent-to-good fracture healing rate (88.6% vs. 60.0%, <jats:italic>P<\/jats:italic>\u2009&amp;lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Small-incision-assisted open reduction reduces operative time, fluoroscopy usage, and improves early functional outcomes. It is a safe and efficient alternative to closed reduction, but larger multi-centre studies are needed for broader validation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2025.1550063","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T05:23:29Z","timestamp":1748323409000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical outcomes of closed reduction vs. small-incision-assisted open reduction with intramedullary nailing in complex comminuted femoral shaft fractures (AO\/OTA 32-C): a retrospective cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Qingwei","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianqiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunyan","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lintao","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongyou","family":"Mu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xubin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e807","DOI":"10.1016\/S2214-109X(17)30222-X","article-title":"National incidence of traumatic fractures in China: a retrospective survey of 512,187 individuals","volume":"5","author":"Chen","year":"2017","journal-title":"Lancet Glob Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.injury.2008.07.017","article-title":"National data of 6409 Swedish inpatients with femoral shaft fractures: stable incidence between 1998 and 2004","volume":"40","author":"Weiss","year":"2009","journal-title":"Injury"},{"key":"B3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.jcot.2012.04.001","article-title":"Proximal femoral fractures: principles of management and review of literature","volume":"3","author":"Mittal","year":"2012","journal-title":"J Clin Orthop Trauma"},{"key":"B4","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1097\/00003086-199705000-00009","article-title":"Current trends in the treatment of femoral shaft fractures in children and adolescents","volume":"338","author":"Buckley","year":"1997","journal-title":"Clin Orthop Relat Res"},{"key":"B5","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1055\/s-0033-1360460","article-title":"Developments in the treatment of pediatric long bone shaft fractures","volume":"23","author":"Lieber","year":"2013","journal-title":"Eur J Pediatr Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"529","DOI":"10.2106\/00004623-198466040-00006","article-title":"Closed intramedullary nailing of femoral fractures. 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