Management of comminuted fractures of the shaft of femur by interlocking nailing at a tertiary level hospital in India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20160045Keywords:
Femur, Fracture, Interlocking nailing, Management, OutcomeAbstract
Background: Fracture shaft of femur is one of the most common fractures encountered in orthopaedic practice. Fracture shaft of femur is major cause of morbidity and mortality in patients who sustain high energy trauma. This study looks at the epidemiology of patients presenting with femur fracture at a tertiary level hospital in Navi Mumbai.
Methods: This prospective study was performed at a tertiary level hospital in Navi Mumbai from January 1, 2014 till July 31, 2015. All patients aged 18 years or above, who presented with comminuted femur fracture and were treated with interlocking nailing was included in the study. Various clinical and radiological parameters were collected during the course of treatment.
Results: 50 patients were included in the study; 84% males. 88% aged 50 years or less. Road traffic accident was the most common mode of injury and 54% of patients had fracture in the middle one-third femur. 76% of the patients presented within 24 hours of injury. 52% of the patient’s demonstrated clinical union of the fracture in 12 to 14 weeks and majority showed radiological union in 16 to 18 weeks. Partial weight bearing was started in 36% patients in 10 weeks and full weight bearing in 42% patients in 16 weeks. Majority of the patients stayed in hospital for 10 to 14 days and the functional outcome as measured by Klemm and Borner criteria was excellent in 66% patients. Complications were seen only in 6 patients.
Conclusions: In our experience, interlocking nailing had very low complication rate and excellent functional outcome in two thirds patients of comminuted femur fracture.
References
Bucholz RW, Jones A. Fractures of the shaft of the femur. J Bone Joint Surg Am. 1991;73(10):1561-6.
Green A, Trafton PG. Early complications in the management of open femur fractures: a retrospective study. J Orthop Trauma. 1991;5(1):51-6.
Grosse A, Christie J, Taglang G, Court-Brown C, McQueen M. Open adult femoral shaft fracture treated by early intramedullary nailing. J Bone Joint Surg Br .1993;75(4):562-5.
Gillespie WJ, Walenkamp GH. Antibiotic prophylaxis for surgery for proximal femoral and other closed long bone fractures. Cochrane Database Syst Rev. 2010:CD000244.
Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma. 2000;48(4):613-21.
Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36(6):691-709.
Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: stable incidence between 1998 and 2004. Injury.2009;40(3):304-8.
Smith RM, Giannoudis PV. Femoral shaft fractures. In: Skeletal Trauma: Basic Science, Management, and Reconstruction, 4th, Browner BD, Jupiter JB, Levine AM, et al. (Eds), WB Saunders, Philadelphia. 2008:2035.
Brumback RJ, Uwagie-Ero S, Lakatos RP, Poka A, Bathon GH, Burgess AR. Intramedullary nailing of femoral shaft fractures. Part II: Fracture-healing with static interlocking fixation. J Bone Joint Surg Am. 1988;70(10):1453-62.
el Moumni M, Leenhouts PA, Duis THJ, Wendt KW. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures. Injury. 2009;40(2):205-8.
American College of Surgeons Committee on Trauma. Advanced Trauma Life Support (ATLS) Student Course Manual, 9th ed, American College of Surgeons, Chicago .2012.
Harvin JA, Harvin WH, Camp E, Caga-Anan Z, Burgess AR, Wade CE et al. Early femur fracture fixation is associated with a reduction in pulmonary complications and hospital charges: a decade of experience with 1,376 diaphyseal femur fractures. J Trauma Acute Care Surg. 2012;73(6):1442-8.
Pape HC, Rixen D, Morley J, Husebye EE, Mueller M, Dumont C et al. Impact of the method of initial stabilization for femoral shaft fractures in patients with multiple injuries at risk for complications (borderline patients). Ann Surg. 2007;246(3):491-9.
Morshed S, Miclau T 3rd, Bembom O, Cohen M, Knudson MM, Colford JM Jr. Delayed internal fixation of femoral shaft fracture reduces mortality among patients with multisystem trauma. J Bone Joint Surg Am. 2009;91(1):3-13.
Jaunoo SS, Harji DP. Damage control surgery. Int J Surg. 2009;7(2):110-3.