Risk Factors and Complications of Femoral Shaft Fractures in Adults

Background: Femoral shaft fractures in adults are major long-bone injuries that commonly follow high-energy trauma and are associated with substantial morbidity, prolonged hospitalization, and clinically important complications. Objective: To determine the frequency, patterns, and predictors of complications among adults with femoral shaft fractures managed at Al-Kadhimiya Teaching Hospital and Imam Ali Hospital, Baghdad, Iraq. Methods: A hospital-based retrospective observational study was conducted from February 1, 2021 to June 30, 2025. Adults (≥18 years) with radiologically confirmed femoral shaft fractures and complete records were included; pathological and periprosthetic fractures and incomplete files were excluded. Data were extracted from admission logs, operative records, and radiology databases. Variables included demographics, injury mechanism, fracture characteristics (including AO/OTA classification), open/closed status, associated injuries, comorbidities (including smoking and diabetes), treatment modality, time to surgery, hospital course, and early/late complications. Standard radiographs were used to assess alignment and union. Results: A total of 312 patients were analyzed (mean age 36.8 ± 12.4 years); most were males (236; 75.64%) and urban residents (204; 65.38%). Road traffic accidents were the leading mechanism (182; 58.33%), followed by falls from height (71; 22.76%). Most fractures were closed (247; 79.17%), with a substantial proportion of open fractures (65; 20.83%). AO/OTA 32-B patterns predominated (131; 41.99%). Intramedullary nailing was the main treatment (208; 66.67%), and the mean time to surgery was 3.4 ± 1.9 days. Major complications included delayed union (36; 11.54%), surgical site infection (29; 9.29%), nonunion (21; 6.73%), malunion (18; 5.77%), and implant failure (15; 4.81%). Significant predictors of major complications were smoking (p=0.002), diabetes (p=0.004), open fractures (p5 days (p