Objective To observe the efficacy and complications of retrograde femoral intramedullary nailing and anterograde femoral intramedullary nailing in the treatment of midshaft fracture of femoral shaft.

Methods A total of 76 patients with middle femoral shaft fracture were included in this study. According to the different placement methods of main screws, they were divided into retrograde group (36 cases) and anterograde group (40 cases). The conditions of perioperation, during follow-up and occurrence of complications of the two groups were compared.

Results There were no significant differences in diameter of intramedullary nail, the number of fluoroscopy, the number of screws at both ends of fracture between the two groups (P > 0.05). In the retrograde group, the operation time was shorter than that in the anterograde group, and amount of bleeding was more than that in the anterograde group (P < 0.05). At the last follow-up, there were no significant differences in fracture healing time, Harris score, Lysholm score and fracture healing rate between the two groups (P > 0.05). The knee flexion degree in the anterograde group was (130.22±4.31)°, which was better than (126.58±8.41)° in the retrograde group, and the incidence of knee pain in the retrograde group was 19.4%, which was significantly higher than 2.5% in the anterograde group (P < 0.05).

Conclusion Both retrograde intramedullary nail and anterograde intramedullary nail can achieve satisfactory clinical effects in the treatment of middle femoral shaft fractures. Retrograde nail placement is relatively convenient without traction bed, but there are relatively more complications in knee joint after retrograde nail fixation.