Management of Transverse Fracture of Shaft of Femur by Intramedullary Interlocking Nail with Dynamic Locking.

Abstract

Fractures of the shaft of the femur are among the most common fractures encountered in orthopaedic practice. The goal in treating a femoral shaft fracture is to promote union, mobilize the patient and restore the function of the limb. The aim of the study was to evaluate the effectiveness of primary dynamization with intramedullary interlocking nail for the treatment of femoral shaft fracture (AO type 32-A3). This prospective study was conducted in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from July 2017 to June 2019. Fifty (50) patients with closed transverse fracture shaft femur (AO type 32-A3) were selected purposively as study participants. Patients with open fracture, pathological fracture, bilateral fracture and fracture at the lower third or neck of the femur were excluded from the study. All patients were treated with primary dynamization with intramedullary interlocking nail and followed up for one year. Final outcome was assessed using Thoresen criteria. The mean ±SD age of the patients was 32.5±11.8 years where most of the patients (92.0%, n=46) were male. The mean ±SD duration of injury of the patients was 13.9±4.7 days and 6 patients (12.0%) had associated injuries. Forty four (44) patients completed the one year follow up. According to the Thoresen criteria, majority of the patients (59.1%, n=26) had excellent outcome and near about one fifth of the patients (22.7%, n=10) had good outcome. Others had moderate (15.9%, n=7) and poor outcome (2.3%, n=1). Excellent outcome was significantly more among patients without associated injury (p=0.036). Primary dynamization with intramedullary interlocking nail is effective for the management of transverse fracture shaft of femur (AO type 32-A3).