A study on management of neglected shaft femur fractures by open intramedullary nailing
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20182743Keywords:
Fracture shaft of femur, Open reduction, Intramedullary, Interlocking nail, UnionAbstract
Background: Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. However, it is not uncommon in developing countries especially in rural India for these injuries to be neglected initially due to the wide spred practice of quackery. The purpose of this study was to evaluate the effectiveness of open intramedullary nailing in the management of neglected fracture shaft femur patients in relation to achievement of union and functional results.
Methods: This was a prospective observational study conducted on 20 patients presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between August 2013 and December 2016, with a diagnosis of neglected fracture shaft of femur. All the patients underwent single stage open reduction and internal fixation with interlocking intramedullary nails. The patients were followed up for a period of 1 year. The patients were analysed for union and functional results.
Results: All the fractures united and the average time of union was 22.6 weeks. The average range of motion of the knees improved from 34 degrees in the preoperative period to 114.5 degrees in the postoperative period. Two patients developed superficial infections at the incision site which resolved with local drainage and oral antibiotics. All the patients were able to return to their preinjury occupation.
Conclusions: Thus results of our study demonstrate that single stage open intramedullary nailing is a safe and effective surgical procedure for the treatment of neglected fractures of shaft of femur.
References
Chapman MW. Closed intramedullary nailing of femoral-shaft fractures: technique and rationale. Contemp Orthop. 1982;4:213.
Clawson DK, Smith RF, Hansen ST. Closed intramedullary nailing of the femur. J Bone Joint Surg. 1971;53:681.
Hansen ST, Winquist RA. Closed intramedullary nailing of the femur: Küntscher technique with reaming. Clin Orthop Relat Res. 1979;138:56.
Veith RG, Hansen Jr ST. Closed intramedullary nailing of femoral-shaft fractures following reaming: technique and rationale. Contemp Orthop. 1982;4:41.
Benirschke SK, Melder I, Henley MB, Routt ML, Smith DG, Chapman JR, et al. Closed interlocking nailing of femoral shaft fractures: assessment of technical complications and functional outcomes by comparison of a prospective database with retrospective review. J Orthop Trauma. 1993;7:118.
Schatzker J. Open intramedullary nailing of the femur. Orthop Clin North Am. 1980;11:623.
Whittaker RP, Heppenstall B, Menkowitz E, Montique F. Comparison of open vs closed rodding femurs utilizing a Sampson rod. J Trauma. 1982;22:461.
Booplan PR, Sait A, Jepegnanam TS, Mattai T, Varghese VD. The efficacy of single-stage open intramedullary nailing of neglected femur fractures. Clin Orthop Relat Res. 2014;472(2):759-64.
Onuminya JE. The role of the traditional bonesetter in primary fracture care in Nigeria. S Afr Med J. 2004;94:652–8.
Onuminya JE, Onabowale BO, Obekpa PO, Ihezue CH. Traditional bone setter’s gangrene. Int Orthop. 1999;23:111–2.
Akinyoola L, Orekha O, Odunsi A. Open intramedullary nailing of neglected femoral shaft fractures: indications and outcome. Acta Orthop Belg. 2011;77:73–7.
Gahukamble A, Nithyananth M, Venkatesh K, Amritanand R, Cherian VM. Open intramedullary nailing in neglected femoral diaphyseal fractures. Injury. 2009;40:209–12.
Mahaisavariya B, Laupattarakasem W. Late open nailing for neglected femoral shaft fractures. Injury. 1995;26:527–9.
Mukherjee SK, Jain V. Neglected femoral diaphyseal fracture. Clin Orthop Relat Res. 2005;431:72–9.
Akinyoola L, Orekha O, Odunsi A. Open intramedullary nailing of neglected femoral shaft fractures: indications and outcome. Acta Orthop Belg. 2011;77:73–7.
