Outcome of Early Closed Interlocking Intramedullary Nailing in Diaphyseal Fractures of Femur

Abstract

Background: The femur is the strongest bone in the body. Fracture femur results from the drawbacks of fast life and violence more frequently as a result of road traffic accidents. Younger working people are more and more falling prey to such high velocity accidents and subsequent disabilities. Femoral shaft fractures are responsible for a huge burden of morbidity and mortality in patients.  Though there are many treatment options but interlocking intramedullary nailing is a good treatment option for femoral diaphyseal fracture. So our aim to find out the outcome of diaphyseal fracture of femur treated by closed reduction with internal fixation by interlocking intramedullary nail. Methodology: This prospective observational study done at Department of Orthopaedic surgery, Dhaka Medical College Hospital, total 19 patient was selected fulfilling the inclusion and exclusion criteria. Closed Intramedullary Interlocking nailing done in all patient within 7 to 10 days of admission and all patient followed up at 2^nd ,6^th, 12^th and 24^th week both clinically and radiologically and result calculated by Friedman and Wyman scoring system. Results: Out of 19 patients male are 15 (78.9%) and female are 4 (21.1%) mean age are 32.84 ranging from 18 to 60 years. RTA is the dominant cause of injury about 73.7% (14) then fall from height are 15.8% (3) and assault 10.5% (2). Interval between injury and operation average 7.36±1.23 days Day ranging from 5 to 10. Operation time required from 80 to 120 minutes. Mean union time is 14.05+/- 1.21 weeks. Out of 19 patient, 17 united uneventfully which is 89.5% one patient need dynamization and one lost follow-up. After calculation by Friedman and Wyman scoring system result found good in 89.5%. Conclusion: In the light of the findings of the study, it can be concluded that early closed Intramedullary interlocking nailing is a very effective, successful and time-tested method of treatment for diaphyseal fractures of femoral shaft. However, limitations of the study suggests that a more extensive, long term and multi centric study with better facility is needed to the confirm or discard above statement.

Keywords: Femoral shaft fracture; Interlocking intramedullary nail; Closed intramedullary nailing; Diaphyseal fracture; Early fixation; Fracture union; Functional outcome; Friedman and Wyman scoring system; Orthopaedic trauma; Bangladesh.