Use of sign intramedullary nailing in open tibia and femur fractures at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Interlocking intramedullary nailing is the current method of choice for fixation of both open and closed tibia and femur fractures. This has been associated with excellent results. Objective: To assess the functional outcome of SIGN intramedullary nailing in the management of open tibia and femur fractures managed at Moi Teaching and Referral Hospital. Design: A retrospective analytical study between February 2005 and December, 2008. Setting: Moi Teaching and Referral Hospital, Eldoret. Subjects: All patients with open tibia and femur fractures who presented at the Moi Teaching and Referral Hospital and had fracture stabilized by SIGN intramedullary nailing during the study period. Results: Forty three open fractures in forty one patients were treated using SIGN intramedullary nailing in the fracture stabilization. Thirty seven (90.2%) of the patients were males while 4 (9.8%)were females. Two (4.9%) patients had bilateral tibial fractures. The average age of the patients was 37 with a range of 14 to 61 years. Road traffic accidents were the leading cause of injury followed by gunshot injuries. Other causes included falls and assault. All patients received surgical antibiotic and tetanus prophylaxis. Antibiotic therapy was maintained post operatively up to a period of two weeks. Patients were discharged with evident satisfactory wound healing and ability to walk on crutches. Irrespective of the fracture configuration, patients were advised to remain non weight bearing for the first 6 weeks. Thirty seven (90.2%) patients turned up for follow up. Sixteen per cent had superficial infections which responded to antibiotic treatment and dressings. Four (11%) had deep infection (3 femur and 1 tibia), 1 in Gustillo IIIB, 2 Gustillo IIIA and 1 Gustillo II. Exchange nailing was done in three patients and one patient had the nail removed and fracture fixed with an external fixator. Conclusion: This study shows good results of intramedullary nailing for grade I, II and IIIA-fractures. We recommend treatment of these injuries by adequate debridement followed by immediate or delayed intramedullary nailing.