Introduction

Various methods of fixation of femur include- intramedullary nailing (antegrade or retrograde), plates and screws. ₁,₂,₃,₄ A prospective study of 100 patients with fracture of shaft femur managed with intramedullary nailing at a level 1 trauma centre in a developing country set up was done.

Material and Methods

A prospective study of 100 patients with fracture of shaft femur managed with intramedullary nailing at a level 1 trauma centre in a developing country set up was done. Patients had either Kuntscher nail or interlocking nail depending on financial status of the patient (Closed or open). Patients were allowed to gradually weight bear only when there was significant bridging callus at the fracture site .Patients were assessed according to degree of knee flexion, duration of fracture healing and complications.(Table 1). They were followed for an average of 2 years.

Figure 1

Table 1

Results

Most of the patients (87%) in the study were males.(Table 2) Majority of the cases were in the second and third decade (63%). The youngest in the study was 17years whereas the oldest was 80 year old (Table 3) Road traffic accident was the etiology in all the patients. The site of fracture was proximal and middle third of the shaft of femur with a right side predominance.(Table 4) 83% of the fracture pattern was transverse with 17% being oblique or communited.(Table 5)

Figure 2

Table 2

Figure 3

Table 3

Figure 4

Table 4

Figure 5

Table 5

60% of the patients were managed with Kuntscher nail and 40% with interlocking nail.(Figures 1,2) The average time of fracture healing was 16 weeks in both the groups.(Figure 3) The results were good in 73% and fair in 25%.(Table 6) There was 3% incidence of infection which was managed successfully with antibiotics. There were 2 cases of implant failure in the patients who had Kuntscher nail, which treated with interlocking nail.(Table 7) There were no cases of non-union in our series.

Figure 6

Figure 1: Fixation of fracture of shaft femur with Kuntscher nail

Figure 7

Figure 2: Fixation of fracture of shaft femur with interlocking nail

Figure 8

Figure 3: Union of the fracture of shaft of femur with significant callus

Figure 9

Table 6

Figure 10

Table 7

Discussion

The various methods of fixation of fracture of shaft of femur include retrograde or antegrade intramedullary nailing, elastic nails or pre drilled Kuntscher nails. Ricci et al in their series of 293 fractures of shaft of femur concluded that the results are same with retrograde or antegrade nailing.₁ Arpacioglu and colleagues had a high success rate in fixation of 48 fractures of shaft of femur with interlocking nail. ₂ Dhakal and co workers in their series of 44 patients with fracture of shaft femur concluded that pre drilled Kuntscher nail is an equally effective way of fixation of fracture of shaft of femur. ₃

In our series of 100 patients with fractures of shaft femur, road traffic accident was the predominant etiology and financial capacity was the basis of deciding the nature of fixation (Kuntscher nailing or Interlocking nail). Majority of the patients were in the second and third decade and there was male predominance. The average healing time in both the groups was similar (16 weeks). There were 2 cases of implant failure with Kuntscher nail which was treated successfully with interlocking nails. Incidence of infection was 3% which as managed successfully with antibiotics.

Conclusion

Kuntscher nails are cost effective and give an acceptable result in the management of fracture of shaft of femur in a developing country set up.

Correspondence to

Mr Rajesh Botchu 5 Magnolia House Springwood Close Maidstone, UK ME16 9PB Ph - 00441622 224335 Fax – 00441622 224335 Email- drbrajesh@yahoo.com