MANAGEMENT OUTCOME OF CLOSED FEMORAL SHAFT FRACTURES BY OPEN SURGICAL IMPLANT GENERATION NETWORK (SIGN) INTERLOCKING NAILS
AbstractBackground: Many hospitals in our country lack surgical expertise and operating room facilitieslike image intensifier and fractures table to carry out closed interlocking nails (ILN) in femoral shaftfractures. But availability of Surgical Implant Generation Network (SIGN) interlocking nails &nailing instrumentation have made open ILN of these fractures possible at very basic level of ourhealth care system. We have carried out open SIGN nailing in patients with closed fractures of shaftfemur without the use of image intensifier. Result for fracture union was evaluated both clinicallyand radio-logically, and graded at 8 months (32 weeks) after treatment by Thoressen’s criteria.Methods: An experimental study of open SIGN nailing was carried out on 47 patients with fracturesshaft of femur who had been admitted to our tertiary care hospital from January 2006 to December2007. Inclusion criteria were adult patients older than 16 years with closed fractures of the shaftfemur, and have presented within a week of the injury, and have not had any previous surgicaltreatment for the fracture. Malnourished patients and patients with open, pathological fractures andnon union cases were excluded from the study. A standard protocol was followed on all patients,which is describing below. The data obtained was analysed using SPSS. Results: The union rate was97.83% in open nailing at 32 weeks after surgery and the Mean±SD time to union was 19.65±5.19weeks (ranges from 16–32 weeks).We obtained excellent results in 39 patients (83.33%), good in 4patients (8.50%), fair in 3 patients (6.38%) and poor in one (2.12%). Conclusions: The open SIGNnailing, without the use of image intensifier, for treatment of closed fractures of shaft femur achievesexcellent result in term of fracture union. Results obtained are comparable to the results of closedinterlocking nailing, requires less expertise and resources, and its use is recommended for long bonesfracture care at the very level of our health care system.Keywords: SIGN nailing, Interlocking nailing, Image intensifier, Closed femoral shaft fracture,image intensifier
Thoresen BO, Alho A, Ekeland A, Stromse K, Folleras G,
Haukebo A. Interlocking intramedullary nailing in femoral shaft
fractures. J Bone Joint Surg 1985;67:1313–20.
M. S. and Fischer S. Gerhard küntscher 1900–1972 J Bone
Joint Surg Am 1974;56:208–9.
Brumback RJ. The rationales of interlocking nailing of the femur,
tibia, and humerus. Clin Orthop Relat Res 1996;324:292–320.
Ikem IC, Ogunlusi JD, Ine HR. Achieving interlocking nails
without using an image intensifier. Int Orthop 2007;31:487–90.
Hashemi-Nejad A, Garlick N, Goddard NJ. A simple jig to ease
the insertion of distal screws in intramedullary locking nails.
Azer SN, Krause WR, Salman NN. Self-guiding interlocking
intramedullary nail. Contemp Orthop 1992;25(1):22–28.
Meena RC, Kundnani V, Hussain Z. Fracture of the shaft of the
femur: Close vs open interlocking nailing. Indian J Orthop
Jesse T. Torbert. Orthopaedia-Collaborative Orthopaedic
Knowledge base. Created Feb 4, 2008 17:58 Last modified Feb
, 2008, 21:27 ver 3. Retrieved 12 Feb 2009. Available from
Grosse A, Christie J, Taglang G, Brown CC, McQueen M. Open
adult femoral shaft fracture treated by early intramedullary
nailing. J Bone Joint Surg Br 1993;75:526–5.
Ali MA, Hussain SA, Khan MS. Evaluation Of Results Of
Interlocking Nails In Femur Fractures Due To High Velocity
Gunshot Injuries. J Ayub Med Coll Abbottabad 2008;20(1):16–9.
Wilber MC, Evans EB. Fractures of the Femoral Shaft Treated
Surgically; Comparative results of early and delayed operative
stabilization. J Bone Joint Surg Am 1978;60:489–91
Grosse A, Kempf I, Lafforgue D. [Le traitement des fracas,
pertes de substance osseuse et pseudarthroses du fémur et du tibia
par l’enclouage verrouillé (à propos de 40 cas).] Rev Chir Orthop
Christie J, Court-Brown C, Kinniworth AW, Howie C.
Intramedullary locking nails in the management of femoral shaft
fractures. J Bone Joint Surg 1988;70-B:206–10.
Anastopoulos G, Aimakopoulos A, Exarchou E, Pantazopoulos
T. Closed interlocked nailing in comminuted and segmental
femoral shaft fractures. J Trauma 1993;35:772–5.
Basumallick MN, Bandopadhyay A. Effect of Dynamization in
Open Interlocking Nailing Of Femoral Fractures. A Prospective
Randomized Comparative Study Of 50 Cases With A 2-Year
Follow-Up. Acta Orthopædica Belgica 2002;68(1):42–8.
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