Early outcome of open locked intramedullary nailing of femoral diaphyseal fractures in a resource – poor setting

Abstract

Background: Closed locked intramedullary nailing is largely considered the preferred treatment option for fractures of the femoral diaphysis, owing to its associated high union and low complication rates. In resource poor regions where intraoperative imaging is not readily available, most of these injuries are treated by open locked intramedullary nailing and plate osteosynthesis. This study was designed to assess the outcome of open locked intramedullary nailing of femoral diaphyseal fractures.

Methods: Medical records and radiographs of all adult patients who had open locked intramedullary nailing of fractures of the femoral diaphysis between January 1, 2013 and July 31, 2017 were retrieved. A total of 45 patients with 46 fractures of the femoral diaphysis were retrospectively studied. Each patient was followed up for at least 12 months. Early outcome of treatment was assessed using the Thorresen's criteria.

Results: A total of 45 patients (24 male; 21 female) with 46 femoral diaphyseal fractures were studied. The age range of the patients was 18 years to 80 years, with a mean age of 33.56 (SD=12.87) years. Forty two (91.3%) cases were closed fractures. Twenty four (53.3%) patients had right femoral diaphyseal fracture. The overall union rate was 95.7%. The range of time to fracture union was 12 weeks to 34 weeks, with an overall mean time to fracture union of 13.65 ± 3.57 weeks. Ipsilateral knee joint stiffness (n=4, 8.7%) and osteomyelitis (n=3, 6.5%) were the commonest complications recorded. Overall infection rate was 10.8%. Using the Thoresen's criteria, the overall outcome of treatment in this study was excellent in 37 (80.4%) patients.

Conclusion: There is no significant difference between the outcome of open nailing compared to closed nailing of femoral diaphyseal fractures

Keywords: Locked intramedullary nailing, femoral diaphyseal fractures