Management of femoral shaft fractures in a tertiary centre, south east Nigeria

Abstract

Background: The femur is the longest and strongest bone in the body. The long straight part of the femur is the shaft. The femoral shaft is circumferentially padded with large muscles. A femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5cm distal to the lesser trochanter and 5cm proximal to the adductor tubercle. This occurs more in young adults. Femoral shaft fractures results from a high energy injury. The forces can be by direct, indirect or a combination of both.

Objective: To determine the cause, pattern of femoral shaft fractures, treatment modalities and their clinical outcome.

Methods: This is a hospital based retrospective study of all patients managed for traumatic femoral shaft fracture over a six year period. Children were excluded from this study. Cases with incomplete records were also excluded. Results were analyzed with Statistical Package for Social Sciences Version 17(SPSS Inc., Chicago, Illinois, USA) and presented in tables.

Results: Two hundred and seventy two (272) fractures were treated in Two hundred and forty two (242) patients. Their ages ranged from 18 to 77years with a mean age of 35.0+4.5years. More males were affected than females with a ratio of 2.4:1.Road traffic accidents were the leading cause of femoral shaft fractures (78%) followed by falls(15%).The most common fracture pattern was oblique, accounting for70% of cases. The treatment modalities involved included both conservative and various operative techniques. There were no differences in the average mobilization time across the operative treated fractures except for Interlocking intramedullary nailing. Complication rates varied across the various treatment modalities. Early surgical intervention showed rather decreased complication rate.

Conclusion: Road traffic accidents are the most common cause of femoral shaft fractures in our environment. Interlocking intramedullary nailing should be the modality of choice for operative treatment. Early surgical stabilization is safe in patients without co-existing multi-systemic injuries. Early mobilization improves clinical outcome.

Keywords: Femoral shaft, Cause, Fracture pattern, Treatment modalities