Short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary sign nail at Muhimbili Orthopaedic Institute in Tanzania

Background: Comminuted femoral shaft fractures are complex to treat because of increased risk of limb length discrepancies and mal-rotation deformities. Currently the interlocking intramedullary nail using image intensifiers is a suggested treatment for comminuted femoral shaft fractures. This study aimed to evaluate the short-term outcome of patients with closed comminuted femoral shaft fracture treated with locking intramedullary SIGN nail without image intensifiers at Muhimbili Orthopaedic Institute (MOI) in Tanzania.
Methods: A prospective hospital base study was conducted on patients with closed comminuted femoral shaft fractures admitted at MOI from March 2011 to February 2012. A total of 91 adult patients (18 to 84 years) were enrolled in the study. Of the total patients, 80 (88%) patients were male, 11 were lost to followup, and 80 patients completed follow-ups of 18 weeks post operatively. Structured questionnaires and checklist forms were used to collect information. Operations were carried out either by antegrade or retrograde SIGN nail. Post operatively control radiographs, the lower limb length and mal-rotation deformities were assessed.
Results: Comminuted femoral shaft fracture accounted for 20.3% of all adult femoral shaft fractures admitted at MOI. Deep wound infection occurred in 2.5%. Shortening of 2-3cm was seen in 3.8% of the patients. No patient had shortening of more than 3cm. External rotation deformity of more than 20 degrees occurred in 6.3% of the cases. Internal rotation deformity of more than 15 degrees was seen in 7.9%. Knee flexion of less than 90 degree was encountered in 7.5% of patients. By 18th week 95% of the patients had callus formation.
Conclusion: SIGN nail appears to be an effective treatment for comminuted femoral shaft fractures in settings where image intensifiers and fracture tables are not readily available. They have excellent to good outcomes in rate of callus formation, limb length and limb alignment outcomes.