Comparison of Closed Versus Open Interlocking Nail Femur: A Retrospective Cohort Study in a Tertiary Care Hospital

Authors

  • Shaikh Naeem-Ul-Haq Assistant Professor, Department of Orthopedic Dow international Medical College/Dow University of Health Sciences Karachi, Sindh-Pakistan
  • Syed Abdur Rub Abidi Assistant Professor, Department of Orthopedic Jinnah Medical & Dental College/JMCH Karachi
  • Syed Amir Jalil Professor, Department of Orthopedic Karachi Medical & Dental Council, Karachi
  • Syed Adnan Ahmed Consultant Orthopedic Surgeon AO Clinic Karachi
  • Zamir Hussain Tunio 5Assistant professor Department of Orthopedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences, Jasmshoro
  • Muhammad Farooq Umer Professor, Department of Surgery Jinnah Medical & Dental College Karachi
  • Taha Junaid Khan Assistant Professor, Department of Orthopedic Jinnah Medical & Dental College/JMCH Karachi

Keywords:

Femur shaft, interlocking nail, delayed union, union, non union, infection.

Abstract

Objective: To compare the results of closed interlocking nail shaft of femur versus open interlocking nail in terms of union, non-union and infection rate.

Methods: We conducted this retrospective Cohort study in Department of Orthopedics Jinnah Medical College Hospital Karachi and Dow University Hospital- Ojha Campus Karachi. The medical record of all patients meeting the inclusion criteria and operated for interlocking nails(closed/open) shaft of femur in the time period extending from 23rd February 2018 to 3rd March 2019 were included in our study. The demographic details, radiographs, operative notes and follow up records of both groups were noted. The post-operative results of union, non-union and infection at final evaluation at one year were compared in both groups. Chi square test was applied and P value calculated. P value < 0.05 was considered significant.

Results: The medical record of 116 patients with mean age 31.1±8 were examined. Closed interlocking nail (group A) was done in 62 patients with mean age 31.1±7.9 years(range 20 to 55 years) while fracture site was opened(group B) in 54 patients with mean age 31.2±8.2years(range 19 to 57 years. The average time of radiological union was 20.5 ±3 weeks in closed versus  26.3±6 weeks in open nailing(  P value <0.05).The rate of union in group A was 95.1%(n=59) and 77.7%(n=42) in group B.(P <0.05) Delayed union was documented in 6(9.6%) patients in group A and 14(25.9%) in group B(P<0.05).Non-union was noted in 03(4.8%) patients in group A and 12(22.2%) patients in group B. Superficial infection was noted in   4(6.4%) in group A and 13(24%) patients in group B.(P <0.05)

Conclusion: Closed interlocking nail for fracture shaft of femur resulted in earlier union, better union rates and less infection rate than open interlocking nail. Every effort must be made to avoid opening fracture side in interlocking nail femur.

References

Fakhry SM, Rutledge R, Dahners LE, Kessler D. Incidence, management and outcome of femoral shaft fractures: A statewide population-based analysis of 2805 adult patients in a rural state. J Trauma. 1994; 37:255-261.

Weiss RJ, Montgomery SM, Al Dabbagh Z, Jansson KA. National data of 6409 Swedish inpatients with femoral shaft fractures: stable incidence between 1998 and 2004. Injury. 2009; 40:304-308.

Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006; 37:691-697.

Giannoudis PV, Giannoudis M, Stavlas P. Damage control Orthopaedics: Lessons learned. Injury. 2009; 40S4:47-52.

Whittle AP, Wood GW. Fractures of the lower extremity. Campbell’s Operative Orthopaedics 10th edition. Philadelphia. Mosby. 2003,p 28-27.

Seetharamaiah VB, Basavarajanna S, Mahendra AR, Vivekanandaswamy AN. Comparison of Closed and Open Interlocking Nailing Techniques In Femoral Shaft Fractures. J of Evidence Based Med & Hlthcare.2015;2(49): 8514-8518.

Kuntscher G, Marknag D. Nailing of femoral fractures. Clin Ortho.1940; 200:400-403.

Street DM. The Evolution of intramedullary nailing. In The science and practice of intramedullary nailing.1st edition. Philadelphia. Mosby. 1987;1-15.

Watson Jones R. Medullary nailing of fractures after fifty years. J Bone Joint Surg. 1950; 32(B):694-700.

Kuntscher G. The Detensor nail for fracture shaft of femur. Clin Ortho. 1968; 75:143-150.

Tahririan MA, Andalib A. Is there a place for open intramedullary nailing in femoral shaft fractures?. Adv Biomed Res.2014;3:157-162.

Taitsman LA, Lynch JR, Agel J, Barei DP, Nork SE. Risk factors for femoral nonunion after femoral shaft fracture. J Trauma.2009;67:1389?92.

Leighton RK, Waddell JP, Kellam JF, Orrell KG. Open versus closed intramedullary nailing of femoral shaft fractures. J Trauma. 1986;26:923?6.

Kisan D, Samant S. A comparison of closed intramedullary nailing with open intramedullary nailing in femoral shaft fractures of adults. International Journal of Orthopaedics Sciences 2018; 4(2): 88-90.

Rand. J. A., Kai Nan A. N., Edmund. Y.S., Patrick. K.; A comparison of effect of open intramedullary nailing and compression plate on fracture site blood flow and fracture union; J. Bone and Joint Surg.1981;60-A (3): 427-442.

Winquist RA, Hansen ST Jr.Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am.1980; 11(3): 633-648.

Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD Pocock SJ, Poole C, et al.) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. PLoS Med.2007;4(10):297-312.

Pati BN, Bansal VP, Krishna LG, Ahmed A, Garg S. Interlocking nail of femur. A review of 90 classes. Ind J Orthop. 2001; 35(1):49-51.

Meena R, Kundnani V, Hussain Z. Fracture of the shaft of the femur: Close vs open interlocking nailing. Indian Journal of Orthopaedics. 2006; 40(4):243.

Ghareghdaghi M, Rahimi H, Bahari M, Afzali J. A prospective study of closed and open reamed intramedullary nailing of 136 femoral shaft fractures in adults. JRMS.2007; 12:16-20.

Chaudhary P, Maharjan R, Kalawar RPS, Baral P, Shah AB.Randomized controlled trial comparing open versus closed interlocking nail for closed fracture shaft of femur in Adults. International Journal of Orthopaedics Sciences.2017; 3(1): 591-595.

Pape HC, Tornetta P, 3rd, Tarkin I, Tzioupis C, Sabeson V, Olson SA. Timing of fracture fixation in multi trauma patients: the role of early total care and damage control surgery. J Am Acad Orthop Surg. 2009;17(9):541-549.

O’Toole RV, O’Brien M, Scalea TM, Habashi N, Pollak AN, Turen CH.Resuscitation before stabilization of femoral fractures limits Acute Respiratory Distress Syndrome in patients with multiple traumatic injuries despite low use of Damage Control Orthopedics. Journal of Trauma-Injury Infection and Critical Care. 2009;67(5):1013-1021.

Riska EB, von Bonsdorff H, Hakkinen S, Jaroma H, Kiviluoto O, Paavilainen T. Prevention of fat embolism by early internal fixation of fractures in patients with multiple injuries. Injury.1976;8(2):110-116.

Goris RJ, Gimbrere JS, van Niekerk JL, Schoots FJ, Booy LH. Early osteosynthesis and prophylactic mechanical ventilation in the multi trauma patient. J Trauma. 1982;22(11):895-903.

Kimmatkar N, Hemnani JT, Hemnani TJ, Jain SK. Diaphyseal Femoral Intramedullary Nailing: Closed or Open Intervention? International Journal of Scientific Study.2014;1(5):15-17.

Kumar SK, Kumar KV. Comparative study of surgical management of fracture shaft of femur with intramedullary interlocking nail:Open VS closed type. National Journal of Clinical Orthopaedics.2018; 2(1): 22-25.

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Published

2020-10-20

How to Cite

Shaikh Naeem-Ul-Haq, Syed Abdur Rub Abidi, Syed Amir Jalil, Syed Adnan Ahmed, Zamir Hussain Tunio, Muhammad Farooq Umer, & Taha Junaid Khan. (2020). Comparison of Closed Versus Open Interlocking Nail Femur: A Retrospective Cohort Study in a Tertiary Care Hospital. Journal of Pakistan Orthopaedic Association, 32(03), 125–130. Retrieved from http://jpoa.org.pk/index.php/upload/article/view/446

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