Analysis of fracture union in intramedullary interlocking nailing in fracture shaft of femur

INTRODUCTION: Fracture of the shaft of the femur is a major cause of morbidity and mortality in patients who sustain high energy trauma.Morbidity arises from limb shortening,malalignment, knee contracture, non union and complications of fracture care.Mortality is infrequent,but can result from ,fat embolism,adult respiratory distress syndrome or resultant multi-organ failure especially in the polytrauma patients .Both morbidity and mortality can be reduced by prompt reduction and internal fixation of the fracture . Restoration of alignment,rotation and length, preservation of the blood supply to aid union and early rehabilitation of patient is the goal of treatment,by achieving the good union at the fracture site. The type and location of the fracture , the degree of communition , the age of the patient , patient’s social and economic status and other factors may influence the method of treatment. Currently intramedullary interlocking nailing is considered to be the treatment of choice for most of the femoral shaft fractures. AIM AND OBJECTIVES OF THE STUDY: To analyse the fracture union in intramedullary interlocking nailing in fracture shaft of femur. Our study involves analysis of fracture union in femoral shaft fractures in the influence of variables like age, open or closed interlocking nailing ,duration between injury and surgery, type of fracture . MATERIALS AND METHODS: A prospective study of interlocking nailing for diaphyseal fracture of femur was conducted from SEP 2007 to SEP 2009 in 60 cases at Coimbatore Medical College Hospital, Coimbatore . Inclusion Criteria - 18 year to 86 years of age • all closed femoral shaft fracture distal to lesser trochanter and up to distal 1\5th femoral shaft • Gustilo Anderson grade I and II open fracture Exclusion Criteria - Age less than 18 years and more than 86 years • Gustilo Anderson grade III open fracture • Pregnant women. Patient with fracture shaft of femur may be in hypovolemic shock requiring blood transfusion and fluid replacement.Since associated injuries are known to occur, involvements of other specialities may be required. After the patient has been stabilized,in skeletal traction in the form of upper tibial pin traction on a Bohler – Braun splint with a weight of 10% of patient body weight is added.This traction reduces unnecessary intraoperative stripping of fragments to reduce the fracture, to prevent soft tissue contracture and maintain the limb length. RESULTS: In our study, Male to Female ratio was 3.2:1 and 67% patients were in the 3rd to 5th decades. The mode of injury in 93% cases was road traffic accident. Two cases were open fractures. The union rate was 85% in the open interlocking nailing and 91% in closed interlocking nailing. The average union time including closed and open interlocking nailing was 5.85 months. The average union time in open interlocking nailing was 6.1 months (4 months to 9 months). The average union time in closed interlocking nail was 5.6 months (3 months to 7 months). Most of our patients had full range of knee and hip movements. Four patients had severe knee stiffness now on physiotherapy. Two patients had deep infection. Exploration, debridement and Irrigation done., infection was controlled with IV antibiotic. The clinico radiological evaluation done for each patient and the final observation were made according to the criteria by Thoresen et al. There was excellent Result in 80% cases, good result in 13% cases, Fair in 3.3% cases. CONCLUSION: This study comprises of mostly Male Patient in their active part of life. So there is a need for quick return to their daily activity. Intramedullary interlocking nailing for femoral shaft fractures performed worldwide because of load sharing property, Torsional rigidity and rotational stability. Reamed nailing does not impede fracture healing and helps in easy insertion Earlier the patients were taken up for surgery easier the reduction and nailing by closed method. Places were imaging facilities are not available, interlocking system with targeting devices are better than free hand technique. Static locking advisable in severely committed fracture to avoid shortening. If fracture gap present Dynamisation should be performed at 14-16 weeks of post operative period. We conclude that closed reamed interlocking intra medullary nail in femoral shaft fracture is the treatment of choice because, patient rehabilitation is early, Hospitalisation is short and fracture union is excellent