ABSTRACT
Background: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries.Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. Methods: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. Results: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. Conclusions: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment
Subject(s)
Bone and Bones , Developing Countries , Fracture Fixation , Fractures, Bone , Open Fracture ReductionABSTRACT
BACKGROUND: Closed, locked intramedullary nailing has been accepted as the gold standard in the care of femoral fractures, with reported union rates as high as 98-100%. Closed, locked intramedullary nailing often requires expensive equipment which is a challenge in developing countries. Segmental long bone fractures are often a result of high-energy trauma and hence often associated with a lot of injuries to the surrounding soft tissues. This consequently results in higher rates of delayed or nonunion. This study was proposed to review the outcome of management of segmental fractures with locked intramedullary nails, using an open method of reduction. METHODS: A retrospective analysis was made of data obtained from all segmental long bone fractures treated with intramedullary nailing over a 1-year period. Records were retrieved from the folders of patients operated on from January 2011 to December 2011. Patients were followed up for a minimum of 1 year after the surgery. RESULTS: We managed a total of 12 segmental long bone fractures in 11 patients. Eight of the 12 fractures were femoral fractures and 10 of the fractures were closed fractures. All but one fracture (91.7%) achieved union within 4 months with no major complications. CONCLUSIONS: Open method of locked intramedullary nailing achieves satisfactory results when used for the management of long bone fractures. The method can be used for segmental fractures of the humerus, femur, and tibia, with high union rates. This is particularly useful in low-income societies where the use of intraoperative imaging may be unavailable or unaffordable. It gives patients in such societies, a chance for comparable outcomes in terms of union rates as well as avoidance of major complications. Larger prospective studies will be necessary to conclusively validate the efficacy of this fixation method in this environment.
ABSTRACT
AIM: To review cases of chronic osteomyelitis managed at a private health institution (Ela Memorial Medical Centre, Ilorin, Nigeria) between March 1995 and February 2005. PATIENTS AND METHODS; Case notes and X-rays of the patients who presented at EMMC with chronic osteomyelitis were reviewed retrospectively. Age, sex, sites of bone involvement and outcome of treatment were recorded. Local surgical debridement (including saucerisation, sequestrectomy and curettage) was the cornerstone of treatment. All patients received antibiotics for at least 6 weeks. RESULTS: Of the 107 cases, 71 (66.4%) were males, with a male-to-female ratio of 2:1. The mean age was 21.9 years (range 1.5 - 80 years). Chronic osteomyelitis is most common in the first and second decades of life (55.2%) and mostly affects people < 50 years of age (93.5%). Haematogenous osteomyelitis was the most common cause of chronic osteomyelitis (81.3%). The most common bone site was the tibia (32.7%). Nearly all (103) were adjudged cured; only 3 patients suffered a recurrence. CONCLUSION: Chronic osteomyelitis is common in Nigeria. Most cases occur in the first and second decades of life, with haematogenous osteomyelitis being the most common cause. A high index of suspicion of osteomyelitis in children with septicaemia, and the proper treatment of patients with open fractures, will help to reduce the occurrence of the disease.
