Adesina Stephen Adesope, Amole Isaac Olusayo, Adefokun Imri Goodness, Adegoke Adepeju Olatayo, Odekhiran Ehimen Oluwadamilare, Akinwumi Akinsola Idowu, Ojo Simeon Ayorinde, Durodola Adewumi Ojeniyi, Awotunde Olufemi Timothy, Ikem Innocent Chiedu, Eyesan Samuel Uwale
Bowen University Teaching Hospital, P. O. Box 15, Ogbomoso, Oyo State, Nigeria.
Bowen University, P.M.B 284, Iwo, Osun State, Nigeria.
Eur J Orthop Surg Traumatol. 2024 Aug;34(6):3109-3117. doi: 10.1007/s00590-024-04040-3. Epub 2024 Jul 4.
To describe the methods and outcomes of reamed intramedullary nailing (IMN) of diaphyseal multifragmentary femur (AO/OTA C2 and C3) fractures (DMFFs) in a low-resource setting without fluoroscopy and fracture table.
The prospective study involved 35 DMFFs among 318 femur fractures treated ≤ 3 weeks post-injury with SIGN nails. The fractures were fixed without fluoroscopy, fracture table and power reaming. Closed, mini-open or open reduction was done. Anatomical length and alignment were ensured using a surgical support triangle during retrograde nailing, and by an assistant during antegrade nailing. Follow-ups were done at 6 weeks, 12 weeks and 6 months.
DMFFs constituted 11.0% of the 318 fractures. Twenty-four (68.6%) were males. The mean age was 39.0 years (range 17-75 years). About 94.3% were injured in road traffic accidents. Fracture reduction was closed in 18, mini-open in 8 and full-open in 9. The operative times were significantly shorter for closed than open reduction (p = 0.001). Five fractures received a supplemental fixation with plate or lag screws. By the 12th post-operative week, 97.1% demonstrated continuing radiographic healing, 94.1% tolerated painless weight-bearing and 91.2% could squat & smile. There was no infection or noticeable rotational malunion. Five fractures healed with a limb-length discrepancy of < 2 cm.
The study demonstrates the feasibility of reamed IMN of DMFFs without fluoroscopy. The outcomes were satisfactory. Although the small sample size and short follow-up period are limitations, the study could serve as a basis for future larger studies in low-resource settings.
描述在无透视设备和骨折手术台的低资源环境下，采用扩髓髓内钉（IMN）治疗股骨干多段骨折（AO/OTA C2和C3型）（DMFFs）的方法及结果。
这项前瞻性研究纳入了318例伤后≤3周接受SIGN髓内钉治疗的股骨骨折患者中的35例DMFFs。骨折固定过程中未使用透视设备、骨折手术台及动力扩髓。采用闭合、微创或切开复位。逆行髓内钉固定时，使用手术支撑三角确保解剖长度和对线；顺行髓内钉固定时，由助手协助。分别在术后6周、12周和6个月进行随访。
DMFFs占318例骨折的11.0%。24例（68.6%）为男性。平均年龄39.0岁（范围17 - 75岁）。约94.3%的患者因道路交通事故受伤。18例采用闭合复位，8例微创复位，9例切开复位。闭合复位的手术时间明显短于切开复位（p = 0.001）。5例骨折采用钢板或拉力螺钉辅助固定。术后第12周时，97.1%的患者影像学显示骨折持续愈合，94.1%的患者能耐受无痛负重，91.2%的患者能蹲坐并露出笑容。无感染或明显的旋转畸形愈合。5例骨折愈合后肢体长度差异<2 cm。
本研究表明在无透视设备的情况下，采用扩髓IMN治疗DMFFs是可行的。结果令人满意。尽管样本量小和随访期短是局限性，但本研究可为未来在低资源环境下开展的更大规模研究提供基础。
