Open Femoral Shaft Fractures in a Developing Country
Pattern of Presentation and Outcome of Treatment
Keywords:
Open fractures, pattern, treatment outcome developing countryAbstract
Background: The femur is one of the principal load‑bearing bones of the lower extremity. Femur fractures are among the most common fractures encountered in orthopaedic practice. Open femur fractures are always as a result of high‑velocity injury and almost invariably associated except for isolated gunshot injuries with multiple traumas. The aim of the study is to determine the pattern of presentation of open femur shaft fractures, associated injuries and outcome of treatment. Patients and Methodology: A 10‑year retrospective study done at National Orthopaedic Hospital, Enugu, from 2007 to 2016. Patients’ folders were retrieved from the Medical Records Department; patients’ biodata, cause of the injury and other relevant information were collated from the folders and their management followed up for 1 year. Data analysis was done with Statistical Product and Services Solution Version 22. Results: A total of 62 cases were reviewed. Treatment outcome of 50 patients that completed their management was analysed. The age range with the highest frequency was 21–30 years. Associated injuries were recorded in 77.4% of the patients. Thoresen’s combined excellent and good outcome was observed in 63.3% of the patients at a minimum of 1‑year follow‑up. Conclusion: Open femoral shaft fractures are more common in the younger age groups and usually associated with high frequency of associated injuries. The outcome of treatment of these fractures in our environment is good despite the limited resources usually encountered in a developing nation like ours.
References
1. Rudloff MI. Fractures of the lower extremity. In: Canale ST, Beaty JH,editors. Campbell Operative Orthopaedics. 12th ed., Vol. 3. St. Louis:Mosby; 2013. p. 2702.
2. Nork SE. Fractures of the shaft of femur. In: Rockwood CA, Green DP,Bucholz RW, editors. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 1846‑914.
3. Giannoudis PV, Papakostidis C, Roberts C. A review of the managementof open fractures of the tibia and femur. J Bone Joint Surg Br2006;88:281‑9.
4. Ifesanya AO, Alonge TO. Operative stabilization of open longbone fractures: A tropical tertiary hospital experience. Niger Med J2012;53:16‑20.
5. Gustilo RB, Anderson JT. Prevention of infection in the treatment of onethousand and twenty‑five open fractures of long bones: Retrospectiveand prospective analyses. J Bone Joint Surg Am 1976;58:453‑8.
6. Gustilo RB, Mendoza RM, Williams DN. Problems in the managementof type III (severe) open fractures: A new classification of type III openfractures. J Trauma 1984;24:742‑6.
7. Ikem IC, Oginni LM, Bamgboye EA. Open fractures of the lower limbin Nigeria. Int Orthop 2001;25:386‑8.
8. Dim EM, Ugwuegbulem OA, Ugbeye ME. Adult traumatic femoralshaft fractures: A review of the literature. Ibom Med J 2012;5:26‑38.
9. Thoresen BO, Alho A, Ekeland A, Strømsøe K, Follerås G, Haukebø A,et al. Interlocking intramedullary nailing in femoral shaft fractures. A report of forty‑eight cases. J Bone Joint Surg Am 1985;67:1313‑20.
10. Nahm NJ, Vallier HA. Timing of definitive treatment of femoral shaftfractures in patients with multiple injuries: A systematic review ofrandomized and nonrandomized trials. J Trauma Acute Care Surg2012;73:1046‑63.
11. Smith JS Jr., Martin LF, Young WW, Macioce DP. Do trauma centersimprove outcome over non‑trauma centers: The evaluation of regionaltrauma care using discharge abstract data and patient managementcategories. J Trauma 1990;30:1533‑8.
12. Khoury A, Weil Y, Liebergall M, Mosheiff R, Israeli Orthopedic TraumaGroup. Outcome of femoral fractures care as a measure of trauma carebetween level I and level II trauma systems in Israel. Trauma Surg AcuteCare Open 2016;1:e000041.
13. Anyaehie UE, Ejimofor OC, Akpuaka FC, Nwadinigwe CU. Pattern offemoral fractures and associated injuries in a Nigerian tertiary traumacentre. Niger J Clin Pract 2015;18:462‑6.
14. Clasper JC, Rowley DI. Outcome, following significant delays in initialsurgery, of ballistic femoral fractures managed without internal orexternal fixation. J Bone Joint Surg Br 2009;91:97‑101.
15. Katchy AU, Agu TC, Nwankwo OE. Femoral shaft fractures in aregional setting. Niger J Med 2000;9:138‑40.
16. Hollis AC, Ebbs SR, Mandari FN. The epidemiology and treatment offemur fractures at a Northern Tanzanian referral centre. Pan Afr Med J2015;22:338.
17. Yinusa W, Ogirima MO. Extremity gunshot injuries in civilian practice:The national orthopaedic hospital Igbobi experience. West Afr J Med2000;19:312‑6.
18. Magerl F, Wyss A, Brunner CH, Binder W. Plate osteosynthesis offemoral shaft fractures in adults. Clin Orthop Rel Res 1979;138:62‑73.
19. Salminen ST, Pihlajamäki HK, Avikainen VJ, Böstman OM. Populationbased epidemiologic and morphologic study of femoral shaft fractures. Clin Orthop Relat Res 2000;(372):241-9.
20. Adili A, Bhandari M, Lachowski RJ, Kwok DC, Dunlop RB. Organinjuries associated with femoral fractures: Implications for severity ofinjury in motor vehicle collisions. J Trauma 1999;46:386‑91.
21. Ferracini AM, Faloppa F, Daltro G, Crisostomo D Jr., Baldy dos Reis F,Belotti JC. Prospective and randomized study of patients with openfractures of the femoral shaft, treated with plate or open intramedullarylocked nail. Acta Orthop Bras 2008;16:102-6.
22. Gustilo RB, Merkow RL, Templeman D. The management of openfractures. J Bone Joint Surg Am 1990;72:299‑304.
23. Seligson D, Henry SL. Treatment of compound fractures. Am J Surg1991;161:693‑701.
24. Harley BJ, Beaupre LA, Jones CA, Dulai SK, Weber DW. The effect oftime to definitive treatment on the rate of nonunion and infection in openfractures. J Orthop Trauma 2002;16:484‑90.
25. Naique SB, Pearse M, Nanchahal J. Management of severe open tibialfractures: The need for combined orthopaedic and plastic surgicaltreatment in specialist centres. J Bone Joint Surg Br 2006;88:351‑7.
26. British Association of Reconstructive and Aesthetic Surgeons. Standardsfor Treatment of Open Fractures of the Lower Leg. British Associationof Reconstructive and Aesthetic Surgeons; 2009.
27. Griffin M, Malahias M, Khan W, Hindocha S. Update on the managementof open lower limb fractures. Open Orthop J 2012;6:571‑7.
28. Louis S, David W, Selvadurai N. Apley’s System of Orthopaedics andFracture. 9th ed. London: Hodder Arnold, An Hachette UK Company;2010. p. 706-10.
29. Williams MM, Askins V, Hinkes EW, Zych GA. Primary reamedintramedullary nailing of open femoral shaft fractures. Clin OrthopRelat Res 1995;(318):182-90.
30. Zlowodzki M, Prakash JS, Aggarwal NK. External fixation of complexfemoral shaft fractures. Int Orthop 2007;31:409‑13.
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Copyright (c) 2019 Henry Chinedum Ekwedigwe, Amechi Uchenna Katchy, Richard Chukwunonye Ezeh, John Kene Anieze (Author)
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