Is open diaphyseal femur fracture managed by delayed interlocking intramedullary nail: A prudent choice?
Abstract
Objective: To review experience of delayed intramedullary nailing of open femur diaphyseal fractures in resource limited setting and to find out frequency of complications.
Methodology: Patients with open diaphyseal femur fracture were admitted through accident and emergency department. After initial resuscitation of the patients, emergency wound debridements were performed. Fractures were stabilized initially by applying skeletal traction. Subsequent debridements were done when indicated. Unreamed intramedullary nailing were done when there was no evidence of wound infection. After discharge, patients were followed up in out patient department every four weeks and complications noted. All patients were followed for at least 6 months.
Results: Forty five open fracture of femur shaft were treated by delayed intramedullary nailing. There were 32 males and 13 females with a mean age of 23 ± 7.3 years. Road traffic accident was the commonest cause of fracture in 30 patients. Delay between injury and surgery was 8.5 (mean) (SD 4.8) days. Average duration of surgery was 60.2 ±17.6 minutes. Closed unreamed interlocking nailing was done in 38 patients, while in 7 patients open intramedullary nailing was done. In five patients postoperative infection was noted, delayed union in five and limb shortening in three patients. Knee joint stiffness was noted in 12 and metal failure in three patients.
Conclusion: In developing countries where facilities for intramedullary nailing in emergency operation theater, are not uniformly available, delayed internal fixation with unreamed interlocking nailing is a good option for the management of open diaphyseal fracture femur.
Methodology: Patients with open diaphyseal femur fracture were admitted through accident and emergency department. After initial resuscitation of the patients, emergency wound debridements were performed. Fractures were stabilized initially by applying skeletal traction. Subsequent debridements were done when indicated. Unreamed intramedullary nailing were done when there was no evidence of wound infection. After discharge, patients were followed up in out patient department every four weeks and complications noted. All patients were followed for at least 6 months.
Results: Forty five open fracture of femur shaft were treated by delayed intramedullary nailing. There were 32 males and 13 females with a mean age of 23 ± 7.3 years. Road traffic accident was the commonest cause of fracture in 30 patients. Delay between injury and surgery was 8.5 (mean) (SD 4.8) days. Average duration of surgery was 60.2 ±17.6 minutes. Closed unreamed interlocking nailing was done in 38 patients, while in 7 patients open intramedullary nailing was done. In five patients postoperative infection was noted, delayed union in five and limb shortening in three patients. Knee joint stiffness was noted in 12 and metal failure in three patients.
Conclusion: In developing countries where facilities for intramedullary nailing in emergency operation theater, are not uniformly available, delayed internal fixation with unreamed interlocking nailing is a good option for the management of open diaphyseal fracture femur.
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