Fracture of the shaft of the femur : Close vs open interlocking nailing

Abstract

Background : Fracture shaft femur is one of the most common fracture treated at tertiary level centre's requiring adequate radiological assistance. Providing distal locking zig arm support in the nail has made it possible to treat fracture shaft femur at primary level with acceptable locking, without the additional support of IITV with added benefits on surgeons part of less expertise, less surgery time, and good to excellent union rates and at the same time on patients part, avoidance of radiological exposure, being economical availability at the next door itself Methods : One hundred and eight fractures of shaft of femora in 104 patients were treated at tertiary level with interlocking nails. Open nailing without IITV was done in 62 and closed nailing under IITV using proximal and distal locking zigs was done in 46 patients). All cases were operated within 24-48 hrs of injury. Results: The union rate at 12 months period was 93% in closed nails and 87.87% in open nails locked with distal zig averaging to 87% overall. Complications were the same as seen with closed interlocking nail involving limb length discrepancy malrotoation infection with added complication failure to lock distal end in few cases. Conclusion : Benefits so derived from open interlocking of fracture long bones can be applied at the very basic level of Indian health infrastructure where the facilities of IITV and surgical expertise are still lacking. Considering the over increasing load of fracture long bones, the results are comparable to that of closed nailing and has benefits on surgeon and patients more suiting to the Indian health infrastructure