A STUDY OF CLOSED INTERLOCKING NAILING FOR FRACTURES OF SHAFT OF FEMUR IN ADULTS

Abstract

BACKGROUND:- This study is to determine the clinical course and results after interlocking nailing for femoral shaft fractures, merits and demerits of interlocking nailing, achieving the final goals of femoral shaft fracture management with special references to time for radiological union, knee stiffness, limb length discrepancy, ambulation and return to work. Femur is the strongest and heaviest bone in the human skeleton. It is also the longest bone contributing 26% to height of an individual. Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice, can cause prolong morbidity and extensive disability unless treatment is appropriate. Many treatment modalities were described; with many surgeons advocating different methods of treatment. At present Interlocking nailing of the femur seems to be the ideal method of treatment for complex femoral fractures. STUDY DESIGN: This is a `Descriptive Study' where Patients attending Outpatient Department of Orthopaedics & Emergency Care Department, Malla Reddy Hospital/ MRIMS, Hyderabad during the study period i. e; December 1st 2011 to August 31st 2012 were screened and a group of 40 patients with unilateral femoral shaft fracture (Closed fractures and Gustilo type I compound fractures) within an age group between 18- 80 years were selected. Patients of age less than 18 years and greater than 80 years are excluded. Patients with Gustilo Type II and Type III compound fractures, associated with Ipsilateral fracture neck and/or distal femur, bilateral fracture shaft femur are excluded. For the selected group closed Interlocking nailing done on fracture table under C-ARM guidance under Regional/ General Anesthesia. Initial non-weight bearing advised. Patients were followed up at regular intervals for some patients' upto 32 weeks. Subsequent weight bearing done as union progressed. RESULTS: The average time to union was 18 weeks ranging from 14 to 32 weeks. Wiss et al; 1, obtained union at an average of 26 weeks with 1.8% non union. We have found no two studies using the same criteria for assessing their results. We have modified Thoresen2 et al. criteria and made it more stringent. Thoresen2 criteria states that 5 degrees of varus, valgus, external or internal rotation or recurvatum were considered as excellent results. In our study excellent result required absolute anatomic alignment. Hence comparison would not hold good. Klemm and Borner3 have had their criteria, which come closer to our criteria. Criteria included pain, deformity, limb length discrepancy, infection, ROM hip and knee. We had 60% excellent, 30% good and 5% fair and 5% poor results. CONCLUSIONS: The findings in our study suggested that Interlocking nailing allowed early protected weight bearing, and joint movement. It has decreased the mortality and dependency of the patient. The rates of infection and non-union or mal-alignment are low. Interlocking intramedullary nailing has proved to be an excellent mode of treatment for complex, comminuted, segmental and unstable femoral fractures. Since the closed intramedullary nailing does not disturb the fracture haematoma, aiding in better healing. Good range of motion is achieved, as the fibrosis due to muscle dissection which is inevitable in open nailing, is avoided by closed nailing. Static nailing with interlocking nailing with interlocking screws both above and below the fracture site secures the best stability of the fracture. Dynamic nailing with interlocking screws only through one of the ends of the nail allows the fracture site to be compressed during early weight bearing and helps in early healing of the fracture. Interlocking has a definite place in the management of Grade-I open fractures. (Delayed, unreamed nailing is preferred.) Fractures of the shaft of the femur associated with metaphyseal fractures, intercondylar fractures, intracapsular fractures can ideally be treated by specially designed interlocking nails, like Recon Nail, Gamma Nail and far distal holed nails.