Functional Outcome of Intramedullary Nailing of the Femoral Shaft Fracture

Abstract

Introduction: Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice. Most of the fracture occurs in young adult due to high velocity injury. It can be life threating due to open wound, fat embolism, ARDS or multiple organ failure. Objective: To assess the functional outcome of intramedullary nailing of the femoral shaft fracture. Methods: The study was a prospective observational study with analytical design was conducted in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, Bangladesh from July 2017 to June 2019. As the study was conducted over a limited period of time, the sample size was adjusted to 50. Patients with closed transverse fracture shaft femur (AO type 32-A3) attending the Emergency and Out Patient Department (OPD) of National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Sher-E-Bangla Nagar, Dhaka, within the defined period were the study population. Results: The mean age of the patients was 32.50±11.81 years where minimum age was 18 years and maximum age was 60 years. Above figure shows that, most of the patients (92.0%, n=46) were male and the rests (8.0%, n=4) were female. Majority of the patients (64.0%, n=32) had injury on right femur and rests (36.0%, n=18) had on left femur. Above table shows that half of the patients, 50.0% (n=25) had duration of injury of 8-14 days and 46.0% (n=23) had duration of injury of 15- 21 days. The mean duration of injury of the patients was 13.90±4.68 days where minimum duration of injury was 5 days and maximum duration of injury was 21 days. Most of the patients (95.5%, n=42) had no postoperative infection and rests (4.5%, n=2) had postoperative infection. Eight patients (18.2%) had internal rotation of knee and 15 patients (34.1%) had external rotation of knee. Majority of the patients (64.1%) who did not have any associated injury had excellent outcome whereas one fifth of the patients (20.0%) who had any associated injury had excellent outcome. Fisher Exact test showed that there was significant association between treatment result and associated injury as p=0.036. Conclusion: Femoral shaft fracture occurs mostly in a male in the active part (young adults) of their life with RTA being the most common etiology. The findings with low complications rate, high incidence of union, shorter hospital stay, early mobility, the excellent functional outcome in terms of alignment and range of motion in the majority of patients makes this technique more reliable and method of choice for femoral shaft fracture in adults.