Interlocking nailing of lower limb fractures at the University of Port Harcourt Teaching Hospital(UPTH), Rivers State

Abstract

Background: The interlocking intramedullary nail has become the standard treatment for most longbone diaphyseal and selected metaphyseal fractures. The Surgical Implant Generation Network (SIGN) intramedullary nail is a set designed for use in treating patients in resource poor regions who need,
but cannot afford an intramedullary interlocking system.

Aim: To assess the demographics, pattern of injuries and surgical outcome of patients with lower limb fractures treated with the SIGN interlocking nails  at the University of Port Harcourt Teaching Hospital.

Methods: All patients who had intramedullary nailing of lower limb long bone fractures between March 2013 and March 2016 using the SIGN nails were  included in this study. Details on demographics, bone fractured and surgical technique were collected using the SIGN database proforma.

Results: Fifty one surgeries were performed on forty eight (48) patients, fourteen females and thirty four males. Male to female ratio was 2.4: 1 and ages  ranged between 18 and 90 years, the mean age being 38.7± 1.6 years. Thirty seven (72.5%) patients had femoral fractures while fourteen (27.5%) patients  had tibial fractures, three (5.9%) of these patients had floating knees. A total of forty nine (96.1%) fractures showed clinical and radiologic  evidence of fracture healing at six months. Total complication rate was 10.5%, and included two (4.2%) cases of surgical site infection, one (2.1%) case of  post- operative bleeding and one (2.1%) case each of missed distal interlock and implant failure.

Conclusion: The advantages of interlocking intramedullary nail fixation of long bone diaphyseal fractures have been well documented. Despite the  disadvantages of opening the fracture site and disrupting the fracture hematoma, the SIGN system, with open reduction of the fracture is quite adequate  in treating these fractures.