Publication:

A study on management of neglected shaft femur fractures by open intramedullary nailing

Background Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. However, it is not uncommon in developing countries especially in rural India for these injuries to be neglected initially due to the wide spred practice of quackery. The purpose of this study was to evaluate the effectiveness of open intramedullary nailing in the management of neglected fracture shaft femur patients in relation to achievement of union and functional results.

Methods This was a prospective observational study conducted on 20 patients presenting to the Orthopaedic OPD of SHKM Government Medical College Hospital, Nalhar, Nuh, Haryana between August 2013 and December 2016, with a diagnosis of neglected fracture shaft of femur. All the patients underwent single stage open reduction and internal fixation with interlocking intramedullary nails. The patients were followed up for a period of 1 year. The patients were analysed for union and functional results.

Results All the fractures united and the average time of union was 22.6 weeks. The average range of motion of the knees improved from 34 degrees in the preoperative period to 114.5 degrees in the postoperative period.  Two patients developed superficial infections at the incision site which resolved with local drainage and oral antibiotics. All the patients were able to return to their preinjury occupation.

Conclusions Thus results of our study demonstrate that single stage open intramedullary nailing is a safe and effective surgical procedure for the treatment of neglected fractures of shaft of femur.