Reamed intramedullary nailing of diaphyseal multifragmentary femur fractures (AO/OTA 32-C) without fluoroscopy guidance: prospective analysis of methods and short-term outcomes in a low-resource setting

• DOI: 10.1007/s00590-024-04040-3
• Publication Date: 2024-07-04T14:02:20Z
• Authors: Stephen Adesope A...; Isaac Olusayo Amole; Imri Goodness Ade...; Adepeju Olatayo A...; Ehimen Oluwadamil...; Akinsola Idowu Ak...; Simeon Ayorinde Ojo; Adewumi Ojeniyi D...; Olufemi Timothy A...; Innocent Chiedu Ikem; Samuel Uwale Eyesan
• Keywords: Male; Adult; Fracture Healing; Adolescent; Operative Time; Middle Aged; Bone Nails; Fracture Fixation, Intramedullary; Closed Fracture Reduction; Young Adult; Open Fracture Reduction; Treatment Outcome; Fluoroscopy; Humans; Female; Prospective Studies; Diaphyses; Femoral Fractures; Developing Countries; Aged

To describe the methods and outcomes of reamed intramedullary nailing (IMN) of diaphyseal multifragmentary femur (AO/OTA C2 and C3) fractures (DMFFs) in a low-resource setting without fluoroscopy and fracture table.The prospective study involved 35 DMFFs among 318 femur fractures treated ≤ 3 weeks post-injury with SIGN nails. The fractures were fixed without fluoroscopy, fracture table and power reaming. Closed, mini-open or open reduction was done. Anatomical length and alignment were ensured using a surgical support triangle during retrograde nailing, and by an assistant during antegrade nailing. Follow-ups were done at 6 weeks, 12 weeks and 6 months.DMFFs constituted 11.0% of the 318 fractures. Twenty-four (68.6%) were males. The mean age was 39.0 years (range 17-75 years). About 94.3% were injured in road traffic accidents. Fracture reduction was closed in 18, mini-open in 8 and full-open in 9. The operative times were significantly shorter for closed than open reduction (p = 0.001). Five fractures received a supplemental fixation with plate or lag screws. By the 12th post-operative week, 97.1% demonstrated continuing radiographic healing, 94.1% tolerated painless weight-bearing and 91.2% could squat & smile. There was no infection or noticeable rotational malunion. Five fractures healed with a limb-length discrepancy of < 2 cm.The study demonstrates the feasibility of reamed IMN of DMFFs without fluoroscopy. The outcomes were satisfactory. Although the small sample size and short follow-up period are limitations, the study could serve as a basis for future larger studies in low-resource settings.