Clinical Outcomes Following Management of Adult Femoral Shaft Fractures by Surgery and Traction at Thika Level 5 Hospital

Abstract

Objective: To compare the clinical outcomes of femoral shaft fractures managed surgically and conservatively by traction.

Design: A prospective quasi experimental study at the Thika level 5 hospital.

Methods: 148 adult patients who had sustained traumatic fractures of femur were prospectively enrolled and assigned into two treatment groups.69(46.6%) patients were enrolled in group A and managed surgically by intramedullary nailing while 79 (53.4%)patients were enrolled in group B and managed by skeletal traction. Patients were purposively assigned into group A after they were able to afford the implants into the surgica group and the rest into the conservative group. Clinical outcomes that were assessed in the wards and clinics included malunion rates, mobility and limb length discrepancy up to three months post discharge. Data was collected by history, physical examination and radiological evaluation using a standardized questionnaire. The data was compiled and analyzed using SPSS version 17. Persons’ chi square, odds ratio and logistic regression were used to measure associations, risk analysis and multivariate analysis.

Results: No significant difference was noted between the two groups in terms of demographic data, fracture type and co;morbidities. Malunion rate of more than 5 degrees was seen in 11(15.9%) patients in group A compared to 34(43.1%) patients in group B (p< 0.001). Seven patients (10.1%) in group A had limb shortening greater than 2 cm compared to 20 patients(25.3%) in group B (P<0.011).Good functional outcomes were achieved in 38 patients (55.1%) who underwent surgery compared to 23 patients (29.1%) managed by traction (p< 0.004)

Conclusion: The data indicates a better clinical outcome of managing femoral shaft fractures by surgery as compared to traction. It also indicates that clinicians in regional referral hospitals should be encouraged to use operative methods in femoral shaft fracture management primarily without delay.

Keywords: fracture shaft femur, clinical outcome, malunion, functional outcome, limb shortening