DIAPHYSEAL FEMORAL FRACTURES

OUTCOME TREATED WITH CLOSE VS OPEN

Abstract

The femur fractures usually happen with oomph forces like motor vehicle
accidents. Objectives: To assess the mode of injury and complications of the management, in
diaphyseal femoral fractures, in comparison of close versus open intramedullary interlocking
nail (IMN). Study Design: Experimental and comparative study. Period: April 2013 to March
2014. Setting: Department of Orthopaedic Surgery, Peoples University of Medical & Health
sciences, Nawabshah. Methods: The cases were divided into two groups A and B. Group A
was treated by open nailing (n = 20) and group B by close nailing (n = 20), all the cases were
operated within 48 hours of admission. All the data were recorded on well structured proforma.
Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographies
were performed as needed postoperatively. Knee, ankle, and hip motions were begun and
protected weight bearing was started on the second day postoperatively and increased
gradually to full WB depending on x-ray findings of callus formation. The patients were followed
for two years. Results of open and closed I.M.N were assessed and the complications if any
were observed over a mean follow-up period of two years. Results: The mean age in group
A was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32(80.0%)
were males with male to female ratio 1:4. Mean ± SD hospital stay was 19.80 ± 14.60 days in
group A, and 17.90 ± 5.95 days in group B (p value 0.55). Average time between injury and
admission was 1.53 days (n = 40), in the group A it was 1.05 days, and in the group B it was
2.0 days (p value 0.03). The average of time between injury and operation in the group A was
8.75 days, and in the group B, it was 8.20 days, (p value 0.71). The average of time between
admission and discharge in the group A was 11.0 days, and in the group B was 9.15 days,
(p value 0.55). Mean ± SD union time was 11.70 ± 6.45 weeks, in group A and 11.90 ± 5.77
weeks, in group B. (p value 0.91). All the patients had full ranged of hip motion and 2 (10.0%)
patients of group A had mild limitation of knee motion with a flexion ranges between 80 and
110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results were
observed in 19 (47.5%) cases, out of them 5(25.0%) were in group A and 14(70.0%) were in
group B. Good results were found in 13(32.5%) patients, out of these 7(35.0%) were in group A
and 6(30.0%) were in group. Fair and poor results were detected in 4(10.0%) cases of group A.
Conclusions: Road traffic accidents by motorcycle was found the commonest (47.5%) cause
of femur fracture, a few complications were observed in open interlocking nailing as compared
to closed interlocking nails.