A five year review of the outcomes of intramedullary nailing of diaphyseal femur fractures in Lusaka

Abstract

Trauma is increasing in Zambia and currently ranks 4th in causing morbidity and mortality (WHO, 2008). Head Injury (HI) and fractures of long bones are the leading cause of hospital admissions among trauma cases. Like most third world countries, Zambia is struggling to offer medical services that would result in timely operative management of fractures (Mock, 1997). Thus, majority of patients wait for long durations for surgery. This has a potential to complicate outcomes such as infection, nonunion, shortening, stiff joints (Nowatarski, 2000). This study reviewed the outcomes of diaphyseal femur fractures managed operatively using Intramedullary Nails (IMNs) in Lusaka from 2009 to 2013. Objectives To review the outcomes of diaphyseal femur fractures managed operatively with IMNs in Lusaka from 2009 to 2013. Methodology This was a retrospective observational study at the University Teaching Hospital (UTH) and Zambia Italian Orthopaedic Hospital (ZIOH). A review of theater registers for patients with femur daiphyseal fractures that were operated on with IMNs during the review period was done. Patients’ file numbers were used to retrieve medical records. 115 records were retrieved and analysed. The burden of patients, clinical & radiological outcomes after surgery and factors associated with nonunion were analysed using frequency tables and graphs. Associations were analysed using appropriate tests. Results There was on average 100.5% increase in the burden of patients with diaphyseal femur fractures managed operatively using IMNs from the year 2010 to 2013. Road traffic accidents accounted for 83% of patients and the majority were males at 83.5% with an average age of 33 years. The average waiting time for surgery was 35.2 days at UTH and 6.2 days at ZIOH which is statistically significantly different. T-tests showed no association between ‘duration from injury to surgery’ and union rates & infection rates. However, the need for bone excision (surgical limb shortening) to achieve reduction was directly related to the ‘duration from injury to surgery’ at UTH, especially if exceeded 29.05 days. Subsequent postoperative Limb Length Discrepancy (LLD) was at 35.3 % and 16.0 % at UTH & ZIOH respectively. The union rates were 82.4% and 86.4% respectively. Age and gender did not influence union of the fractures. Conclusion The burden of patients with diaphyseal femur fractures managed operatively using IMNs doubled from the year 2010 to 2013. UTH is overwhelmed with this burden resulting in long waiting time for surgery, averaging 35.2 days. The longer the waiting time for surgery, the more likely the need for bone excision leading to limb shortening. The outcomes of surgery in Lusaka are comparable with other centers across the world except for high incidence of postoperative LLD