Outcome of surgical implant generation network nail initiative in treatment of long bone shaft fractures in Kenya

Abstract

Patients: Seventy eight patients with 60 femur and 20 tibia fractures were prospectively done SIGN locked IM nail between December 2005 and December 2007. Patient demographics, cause of injury, fracture pattern and indication for intervention that included recent fractures, non union, mal-union and implant failure of either femur and/or tibia shaft fracture were studied. Preoperatively assessment of patients included routine laboratory, X rays and consent forms. Post-operative management included antibiotics, check X rays and physiotherapy. Patients were discharged on non weight bearing crutches and initially followed at two weekly intervals then every month. Fifty five (55) patients were followed beyond 30 weeks post-operatively. 51 patients healed while four had complications and needed re-operation. Twenty five were lost to follow-up and union not assessed. Implant characteristics and procedure: SIGN nail is a solid nail with a 5 degree bend in proximal 5 cm. It has two dynamic locking slots distally and one dynamic and one static slot proximally. The diameters vary from 8mm to 12mm and the length from 280mm to 420mm. It was initially designed for tibia but its use has been extended to femur and humerus. Interlocking is achieved with the help of external jig, sleeves and slot finders. Operation was done on flat theatre table with the patient supine and a sand bag either below the operated hip or knee. In antegrade femur approach nail is inserted through the tip of the greater trochanter. Retrograde femur approach is through the intercondylar notch non articular area. Tibia approach is through para-patella incision 1cm below the joint line. Fracture reduction was done open in most cases except for a few cases of fresh tibia fractures. All fractures were reamed and drilled by hand. Clinical outcome: Interlocking rates, duration of surgery and fracture healing indices including; non weight bearing time, partial weight bearing time, knee range of motion, serial monthly X-rays and complications were collected at follow up visit by the surgeon. A fracture was considered united if there was bridging callus on two cortices of two views of X-rays and the patients had painless weight bearing. Statistical analysis: This was done using SPSS version 10 to derive descriptive statistics.