Is early intramedullary interlocked nailing an effective treatment option for open grade III femoral shaft fractures: a systematic review of literature and pooled analysis of 176 cases.

Background: Open Grade 3 femoral fractures are high-velocity injuries, often associated with other co-morbid injuries and are highly prone to infections; these fractures are commonly treated by staged procedures to minimize the complications. Early definitive fixation by intramedullary (IM) interlocking nails (ILN) has advantages like early mobility and better outcomes.

Study question: Are early definitive fixations of grade III shaft femur fractures with debridement & IM ILN effective in union and infection rates?

Materials and methods: Using relevant keywords, a total of 3357 articles were screened from the PubMed, Scopus and Embase database. 6 studies that evaluated at least 10 cases of grade III open femoral shaft fractures treated with early IM ILN during the index surgery were included in this review.

Results: Out of the 6 studies, only 1 was prospective, and the remaining 5 were retrospective in design. Out of 176 Grade III fractures, there were 8 non-unions, 3 malunions and 1 case of delayed union. Pooled analysis showed union rates of 94.8% for these fractures (4 studies). Infection was the most common complication. Pooled analysis showed that the mean rate of infection in these grade III fractures was 6.7%. Other complications included limb length discrepancy and stiff knee.

Conclusion: Intramedullary nailing in grade 3 femoral fractures as an early method of definitive fixation is an effective option. In such cases, optimizing controllable variables like surgical expertise and adequate antibiotic prophylaxis can improve outcomes.