Management of long bone fractures using SIGN nail: experience from a Nigerian Hospital
Background: Intramedullary nailing with interlocking nails has become the treatment of choice for closed diaphyseal fractures of femur and tibia. When possible locked nailing should be performed as a closed procedure. Fractures fixed by interlocking nailing have comparatively less complications in fracture healing.
Methods: A retrospective study of all fractures treated using SIGN nailing system at the Lagos University Teaching Hospital between December 2011 and November 2015 was carried out using information obtained from patient records and SIGN data base. These included biodata, aetiology of fractures, fracture type, injury presentation interval, associated lesions, outcome as well as complications and challenges in treatment.
Results: A total of 184 fixations in 169 patients were carried out over a 4years period. The studied patients were aged 17 to 88years with mean of 37.66± 13.98years. One hundred and sixteen (65.2%) were aged below 40 years. There were 121 males and 48 females showing a male to female ratio 2.5:1. Road traffic accident was the most common aetiology (70.8%) The acute (recent) fractures made up about 86% of the cases seen while chronic fractures were 14%, this included malunited fracture 3.8% and non-union 10.2% The surgical approaches were ante grade in 115 cases (62.5%) and retrograde in 69 (37.5%) cases. All the retrograde procedures were performed on the femur. Fifteen patients had multiple fixations The most frequently fixed fracture using SIGN nail were femur 62.5%, tibia 31.5% and humerus 6%. The major challenges included multiple fixations in multiply injured patient as well as Fixation in non- union and malunion of three to four years post injury without image intensifier.
Conclusion: Sign interlocking nail system is very effective in treatment of long bone fractures. The major challenges were seen in multiply injured patients with multiple fractures. Also patients that present after several years of injury with malunion and\or non-union may pose some challenges in treatment using SIGN nail.
Keywords: Sign, Intramedullary Nail, Image Intensifier, External Jig, Fractures