Open intramedullary nailing using ‘Greens Instrumentation’ in the treatment of femoral and tibial shaft fractures: a 5 years review of cases in a private health facility in the Niger Delta region of Nigeria

Background: Open reduction and intramedullary locked nailing using external jig (usually without intra-operative imaging) is gaining widespread popularity in developing and resource-poor countries for the management of lower limb long bone shaft fractures. I share our experience using the “Greens” instrumentation in the treatment of femoral and tibial shaft fractures in a private health facility in Delta State, Nigeria. Methods: This was a retrospective review of patients who had lower limb long bone shaft fractures seen and treated with open intramedullary nailing at a private health facility in Warri, Delta state Nigeria, over a five year period. Results: There were 20 patients with 21 lower limb long bone shaft fractures made of 13 males and 7 females (M:F = 1.5:1). Average age of patients was 42±18 years. Fifty per cent of the fractures were caused by RTA. The femur was affected in 19 fractures (90.5%) and 2 fractures affected the tibia (9.5%). Three of the fractures were open. Sixteen patients presented fresh (within 2 weeks of fracture) while the rest 4 presented at an average of 7.8±1.5 months post fracture with various complications after treatment elsewhere. All patients except 1 had open nailing. Average length of hospital stay was 19.0±9.3 days. The average time between surgery and partial weight bearing was 10.0±6.7 weeks while mean time to full weight bearing was 18.5± 6.7 weeks. Complications included deep infections in 2 patients, distal screw displacement due to early weight (against instruction) in 1 patient, delayed union in 1 patient and death of 3 patients. Conclusion: Open IM nailing of femoral and tibial shaft fractures with the “Greens” instrumentation is an effective treatment method in resource-poor settings like ours where intra-operative imaging is not readily available.