Indications and outcome of Open Reduction and Internal Fixation of Long Bones in Benue State North Central Nigeria

Abstract

Background: Open reduction and internal fixation (ORIF) is a  well-established surgical treatment of fractures worldwide. However, the indications and modes of stabilization of long bone fractures vary and are evolving .The general trend now is towards fixation with locked intramedullary nail (i.m nail) rather than plate and screws.
Objective: To identify the common indications for ORIF in our  environment, the implant commonly used and ascertain the outcome of such fixations.
Materials and Methods: A four year retrospective review of all the patients who had ORIF at NKST Rehabilitation Hospital Mkar Benue State between January 2007 and December 2010 was done. The data obtained included the age, sex, diagnosis, implant used (plate and screws or i.m nail), outcome (united or failed implant), complications and bones involved. All
case notes with incomplete data were excluded from the study. Follow up was for 24 months. The data was analyzed using SPSS 16.
Results: There were 361 ORIF done on 355 patients, 245(66.4%) males and 124(33.6%) females giving a male to female ratio of 2:1. The age range was 3 to 82 years with mean age of 36.4 years (SD 14.7). The indications for ORIF were closed fractures 187(50.7%), Nonunion  103(27.9%), Malunion 57 (15.4%), Failed implant 13(3.5%), Delayed union 4(1.1%), open fracture 4(1.1%), and congenital pseudoarthrosis of the tibia 1(0.3%). The commonest bone involved was the femur  205(55.6%) followed by the tibia and fibula 78(21.1%) and humerus 58(15.7%) then others 28(7.6%). Plate and screws were used in  354(95.1%), i.m nail in 15(4.1%). The fractures that united were  357(96.7%), 12(10 plates and screws, 2 i.m nails) (3.3%) had failed implant. Infection was documented in 8(2.2%), joint stiffness in 4(1.1%) and limb length discrepancy in 4(1.1%).
Conclusion: The study shows that plates and screws are the commonest implants used at NKST Rehabilitation Hospital. Closed fractures are the commonest mode of presentation, and the femur is the commonest bone fractured that requires ORIF. The fracture union rate is also acceptable but might be better if intramedullary nails are used where indicated.

Key words: Plates and screws, nails, implant closed fracture, fracture union, Benue.