First Experience with Locked intramedullary nailing of the femur in Kashmir

Abstract

An experience with 30 cases done between September 2002 and September 2004 at the Bone & Joint Surgery Hospital Srinagar Kashmir is reported. 30 cases of closed Diaphyseal femoral fractures were operated upon by closed antegrade intramedullary interlocking nailing and results assessed as per Pintore et al (1992). 23 cases were locked statically & 7 cases dynamically. One case was dynamised at 14 weeks. No Non-unions were noted. INTRODUCTION Femoral shaft fractures are amongst the most common fractures encountered in orthopedic practice. These may result in prolonged morbidity and extensive disability unless the treatment is appropriate (8). Reamed nailing for lower limb fractures is a well established technique (5). Interlocking nailing widens the surgical indications of nailing, allowing it to be used for comminuted fractures, on fractures too proximal or too distal to be operated on without interlocking(9)and on aseptic pseudoarthrosis(3,9). 30 cases with closed femoral fractures admitted to the Bone & joint Hospital were included in this study. The purpose of this study was to assess the results of application of this technique to these patients. MATERIAL AND METHODS 30 patients with closed diaphyseal femoral fractures were included in this study. The age of all these patients was more than 18 years. Exclusion criteria used in this study were: a-open fractures b-polytrauma c->3wk old trauma dpathological fractures e-patients with ligamentous knee injuries All patients were assessed thoroughly and investigated. SURGERY After the requisite anesthesia the patient was placed in supine position and traction table was used. The affected limb was adducted and the hip flexed to 25-30o. The foot of this limb was kept in 15 o internal rotations due to 15o anteversion. The incision was given from just distal to the greater trochanter to about 6-8cms proximal & posterior. Using a curved awl, the pyriform fossa was breached in the midplane of the femur in both AP & lateral views. Manipulative reduction of the fracture was done and a 3.2 mm guide rod was introduced. The femur was reamed over the guide wire by means of various sized reamers in 0.5 mm increments. The proximal femur was reamed 1mm more than the predetermined diameter of the nail. The nail was introduced and seated. Proximal locking was done by means of a jig and the distal locking was done by freehand technique. POSTOPERATIVE REHABILITATION After the operation immediate quadriceps muscle setting exercises and range of motion was begun on the morning after operation. Toe touch crutch walking was allowed depending upon the configuration of the fracture. Progressive weight bearing was allowed depending upon clinical & radiological union. Review was carried out monthly until final assessment First Experience with Locked intramedullary nailing of the femur in Kashmir 2 of 4 which was done at 6 months. RESULTS The results were assessed as per the following tables: 1-AGE