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Title: An Experience in Managing an open Fracture Shaft of the Femur Due to a Gunshot with Intramedullary Interlocking Nailing
Authors: Fayyaz Ahmed Orfi, Shafqat Hussain, Shafaan Orfi, Ali Arslan Munir, Sumbal Rana, Nida Maryam
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: 6
Language: English
Keywords: InfectionIntramedullary nailingbone unionOpen fracture
Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily.
Study Design: Prospective longitudinal study
Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021.
Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo–Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved.
Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved.
Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if early good debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization.
To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily.
Prospective longitudinal study involving 53 cases of open fracture of the femur shaft due to gunshot. Patients underwent initial wound debridement, X-ray classification (Gustilo-Anderson), and fixation with titanium I/M I/L Nail in static mode. Rehabilitation was initiated post-operation, and outcomes were assessed for infection, range of motion at the knee, full weight bearing, and radiological union. Data was analyzed using SPSS version 23.00 and MS Excel 2016.
graph TD
A["Patient Recruitment 53 cases of open femur shaft GSW"] --> B["Initial Wound Debridement & Tetanus Prophylaxis"];
B --> C["X-ray & Gustilo-Anderson Classification"];
C --> D["Antibiotics & Wound Cultures"];
D --> E["Delayed Fixation: 4-7 days post-injury"];
E --> F["Intramedullary Interlocking Nailing - Static Mode"];
F --> G["Post-operative Care & Rehabilitation"];
G --> H["Regular Follow-up & Assessments"];
H --> I["Data Analysis"];
I --> J["Outcome Evaluation Union, Complications, Functional Scores"];
J --> K["Conclusion & Discussion"];
Primary intramedullary (IM) interlocking nailing is presented as a preferred treatment for Type 1 and 2 femur shaft fractures, especially with early and thorough debridement. This approach aims to avoid secondary procedures, reduce complications, and facilitate early mobilization. The study's findings on infection rates, leg length discrepancy, and functional outcomes are compared with other studies, showing comparable results. The discussion also touches upon the challenges of managing open femur fractures due to gunshot wounds and the importance of soft tissue management.
- 64.15% of patients had Type-1 fractures and 35.8% had Type-2 fractures.
- Fracture union was observed in 88.67% of patients after three months and 11.32% over the next five months.
- Complications included wound infections (9.44%), leg length discrepancy (7.53%), and non-union (3.77%) at six months.
- Bone grafting was performed for the two non-union cases, leading to union.
- 96.2% of patients achieved more than 110° of knee flexion.
- Functional outcomes were rated as excellent in 56.60%, good in 26.41%, fair in 11.32%, and poor in 5.66%.
Primary intramedullary (IM) nailing is the preferred mode of treatment for Type 1 and 2 femur shaft fractures when early, good debridement is performed. It offers advantages such as avoiding secondary procedures, having fewer complications, and promoting early mobilization.
- Number of patients: 53 cases of open fracture of the femur shaft due to gunshot were included.
- Union rate: Fracture union was observed in 88.67% of patients after three months.
- Complication rate: Wound infections occurred in 5 (9.44%) patients.
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