Primary intramedullary nailing in compound Type 1 and 2 femur shaft fractures and their effect on functional outcome

Abstract

Background: Femur shaft fractures are the most common long bone fractures encountered in orthopedic practice. Open fractures of the femur shaft are due to high-energy trauma; these patients are usually associated with other system injuries and vascular involvement. The initial management of open fractures includes antibiotics, debridement, and stabilization. If the initial debridement is believed to be adequate, definitive fixation of the femoral shaft can be performed usually with reamed intramedullary nailing. The present study was conducted to evaluate the functional outcome in open Type 1 and 2 femur shaft fractures managed with primary intramedullary nailing and the complications related to it. Materials and Methods: Twenty-two patients, having Grade 1 and 2 compound femur shaft fractures were admitted and included in the study from January 2016 to February 2019 after obtaining valid consent. All the patients were investigated with X-rays, and fractures were classified according to Gustilo–Anderson classification. All the patients were treated primarily with intramedullary nailing, and the functional outcome was assessed by using Harris Hip Score and Oxford Knee Score. Results: Thirteen (59.09%) patients had Type 1 open femur shaft fractures and nine (40.90%) patients had Type 2 fractures. Fracture union was observed in six patients (27.27%) at 3 months and in 16 (72.72%) at 3–6 months. Complications observed were superficial wound infections in two patients, deep infections in two patients, and nonunion in one patient. Thirteen (59.09%) patients got excellent outcome, four (18.18%) patients got good outcome, three (13.63%) patients got fair outcome, and two (09.09%) patients got poor outcome. Conclusion: Primary intramedullary nailing is an effective method of managing Type 1 and 2 open femur shaft fractures if thorough early and timely debridement can be done. It is associated with less complications, helps in early mobilisation and also avoids secondary procedures.