Treatment outcomes of open femoral fractures at a county Hospital in Nakuru, Kenya

Abstract

Background: Fracture femur is a common injury seen in patients presenting to the emergency unit. The management is mostly operative and in few selected cases, cast application or traction this is mainly in children and patients who cannot withstand anaesthesia for surgical operation to be done. Operative care is done for either open or closed fractures. Open femur fractures are uncommon injuries at the Nakuru County Hospital. The advent of motorbikes as a convenient mode of transport and proliferation of small arms in untrained (criminal) hands has aggravated the burden of open femur fractures either alone or as part of other injuries. Early fixation of such fractures is the practice at the hospital yet the outcomes of this approach have not been documented.
Objective: The study evaluates the treatment outcomes of patients admitted with open femur fractures and relates these to fracture patterns and the modified Gustillo- Anderson classification.
Method: This was a prospective review of patients admitted with open femur fractures in Nakuru County Hospital Kenya between January 2017 and July 2017. The fractures were managed by primary intramedullary nailing after debridement. Data extracted included mechanism of injury, the classification using Gustillo- Anderson classification -location of the fracture and treatment outcome four months after immediate open reamed interlocking nailing.
Results: One hundred and seventy six femur fractures were recorded. Thirty six patients with unilateral and two with bilateral open femur shaft fractures were enrolled. Majority (85.1%) were male; with a mean age of 31 years (range 25-60 years). Twenty four fractures were in the distal third of the femur constituting 57.89%, (n = 24): Gustillo- Anderson grade IIIA and above were 76.31% and majority of the open fractures were due to road traffic accidents 68.42%, (n=26) and gunshot 15.79%,(n=6) respectively. Overall, open femur fractures in 30 (78.95%) patients healed without complications at 4 months.
Conclusion: Open femoral fractures are common following road collisions. Most are severe but managed by primary intramedullary fixation at debridement healed with excellent results.

Key words: Open femoral fracture, Gustillo-Anderson, Intramedullary nail fixation