Outcome of Closed Reamed Interlocking Nailing in Closed Diaphyseal Femoral Fracture in Adult

Author(s): Sharif Hossain, Mahbuba Sultana, Molla Muhammad Abdullah Al Mamun, Minhaz Uddin, Khaled Mahmud

Background: Diaphyseal femur fracture most commonly occurs due to high-velocity trauma. There are various treatment modalities for diaphyseal femur fracture in adults: traction, brace, platting, intramedullary nail, external fixator, and intramedullary interlocking nail.

Aim: To evaluate the functional outcome of treatment of diaphyseal fracture of the femur by closed-reamed interlocking intramedullary nail.

Methods: This Quasi-experimental study was conducted in the Dhaka Medical College Hospital, Dhaka, to analyze the clinical and radiological outcome of Closed Interlocking Intramedullary Nailing in Diaphyseal Fractures of the Femur. For this purpose, among admitted patients, a total of 38 patients were selected who fulfilled the inclusion and exclusion criteria. All relevant data of the patient was recorded according to the questionnaire. The SPSS computer software program, version 22.0, analyzed data. The level of significance was set at 0.05 (P < 0.05).

Result: Among 38 patients, the mean age was 32.84 ± 13.94 years (age range 18-60 years); the majority of the patients, 10(26.3%), were in the second decade as well as 10(26.3%) in the third decade and 8(21.1%) in the fourth decade. Male: Female ratio 2.8:1. Road traffic accidents in 30(78.9%) patients were observed to be the main cause in this series, followed by fall from height in 6(15.8%) cases. In this study, transverse fractures were 24 (63.1%), spiral fractures were 8(21.1%), and oblique were 6(15.8%) cases. Majority patients 30(78.9%) had full range of knee flexion (>120 degree), 6(15.8%) patients had <90 degree and 2(5.3%) patients 110 degree of knee flexion. Only 2(5.3%) patients had a 1cm limb length discrepancy, and 4(10.5%) patients had 5 degrees of malalignment. The mean hospital stay was 11.7 ± 2.3 days (8-15 days). The union rate was found in 94.7% of cases. The mean union time was 14.3±4.1 weeks. The mean operative time was 101.6±23.6 minutes. Functional outcome was assessed based on the Friedman and Wyman scoring system. Good results were obtained in 32 cases (84.2%), fair results in 6 cases (15.8%), and no poor outcome was found.

Conclusion: Closed Intramedullary interlocking nailing is an effective treatment method for diaphyseal fractures of the femur because of stable fixation, higher rate of union, lower rate of complications like infection or non-union, and allows early weight-bearing return to activities.