Gunshot fractures of tibia and femur - excellent results with reamed bone marrow graft and interlocking nailing

Objective: To document the outcome of treatment of femur and tibia diaphyseal fractures due to gunshot injury grafted with reamed bone marrow and immobilised with Surgical Implant Generation Network (SIGN) interlocking nail.Design: A prospective study.Setting: Three referral centres in two developing countriesSubjects: Thirty-three patients with 36 fractures due to gunshot injury were studied.Interventions: Stabilised patients were commenced on prophylactic parenteral antibiotic; X-rays done to classify fractures by Gustillo-Anderson classification. Documented were entry, exit wounds and neurovascular status of the limb. Bone marrow was reamed manually and collected oozing reamed marrow was used as graft. Drain was used minimally and when used, was placed where the reamed marrow would not be drained.Patients were followed-up between one to three years.Mean outcome measure: Clinical and radiological evidences of healing of the fracture at six weeks.Results: Patients age ranged between 15-70 years with mean of 32.2±12.2 years. M : F 32:1. Thirty-one (86.1 %) were femoral fractures and 15 (41.7%) of studied long bone fractures were around the knees. The fractures were mainly Gustillo- Anderson type I (41.7%) and II (41.7%). At six weeks there was massive callus formation in 86.1 % of the fractures sites. All other fractures healed within three to four months except one fracture. Conclusion: Fractures of femur and tibia fractures due to gunshot injury fixed with SIGN intramedullary interlocking nails and grafted with reamed bone marrow give excellent result. This may be due to the use of harvested osteogenic and osteoinductive bone marrow