Exchange nailing for non-union of femoral shaft fractures.

BACKGROUND: There are many ways to treat aseptic non-union of femoral shaft fractures with reported varied success rate. Amongst all these, Exchange nailing is the simplest and most successful technique for treating aseptic non union of femoral shaft fractures. We have carried out a prospective study in the Department of Trauma & Orthopaedics, Ayub Medical College Abbottabad to analyse the role of exchange nailing for aseptic non union of femoral shaft fractures. METHODS: Forty-three femoral shaft aseptic non-unions in 41 consecutive patients were treated using exchange IM nailing, from January 2006 to December 2007. The inclusion criteria for patients in the study was a femoral shaft fractures aseptic non-union, has less than 1 Cm shortening with no segmental bone defect, and a radiolucent line of the non-union, and which had previously been treated by intra-medullary nail. The surgical technique included removal of previously inserted intra-medullary nail, reaming of medullary cavity up to 2 mm above the previous size, and re-insertion of statically locked exchange intra-medullary nail. RESULTS: Forty-three femoral shaft aseptic non-union in 41 patients were treated; the mean age of the patients was 38.81 +/- 13.75 years. Thirty-nine non-union out of total 43 cases (39/43) had healed giving a union rate of 90%. Non-union persisted in the remaining four cases (4/43) in-spite of extended post operative follow up of these patients for 18 months. Mean union was 4.97 +/- 1.53 months. No major surgical complications were noted. CONCLUSION: Exchange nailing is a simple technique for treating aseptic non union of femoral shaft fractures. Based on the results of our study, we recommend it as the procedure of choice for non comminuted, aseptic non union of femoral shaft fracture.

Management outcome of closed femoral shaft fractures by open Surgical Implant Generation Network (SIGN) interlocking nails.

BACKGROUND: Many hospitals in our country lack surgical expertise and operating room facilities like image intensifier and fractures table to carry out closed interlocking nails (ILN) in femoral shaft fractures. But availability of Surgical Implant Generation Network (SIGN) interlocking nails & nailing instrumentation have made open ILN of these fractures possible at very basic level of our health care system. We have carried out open SIGN nailing in patients with closed fractures of shaft femur without the use of image intensifier. Result for fracture union was evaluated both clinically and radio-logically, and graded at 8 months (32 weeks) after treatment by Thoressen's criteria. METHODS: An experimental study of open SIGN nailing was carried out on 47 patients with fractures shaft of femur who had been admitted to our tertiary care hospital from January 2006 to December 2007. Inclusion criteria were adult patients older than 16 years with closed fractures of the shaft femur, and have presented within a week of the injury, and have not had any previous surgical treatment for the fracture. Malnourished patients and patients with open, pathological fractures and non union cases were excluded from the study. A standard protocol was followed on all patients, which is describing below. The data obtained was analysed using SPSS. RESULTS: The union rate was 97.83% in open nailing at 32 weeks after surgery and the Mean +/- SD time to union was 19.65 +/- 5.19 weeks (ranges from 16-32 weeks).We obtained excellent results in 39 patients (83.33%), good in 4 patients (8.50%), fair in 3 patients (6.38%) and poor in one (2.12%). CONCLUSIONS: The open SIGN nailing, without the use of image intensifier, for treatment of closed fractures of shaft femur achieves excellent result in term of fracture union. Results obtained are comparable to the results of closed interlocking nailing, requires less expertise and resources, and its use is recommended for long bones fracture care at the very level of our health care system.