Intramedullary nailing in segmental fractures of shaft of femur: analysis of parameters influencing time to union.

PURPOSE

Segmental fractures, being associated with high energy trauma, are quite intimidating for the treating surgeon due to wide incidence of complications. The soft tissue damage and the fracture pattern in segmental fractures further disrupt the precarious nutrition of the floating intercalary segment, affecting fracture healing. Our study analyses the parameters influencing time to union in segmental fractures of femur.

METHODS

A retrospective analysis of all patients who presented to our level 1 trauma centre between January 2015 and December 2020 with traumatic segmental fractures of shaft of femur was done and were followed up post operatively till fracture union. Data regarding the number of segments, wedge fragmentation, presence of comminution, length of individual segments, and complications were all retrieved from the patients' records.

RESULTS

Forty-two patients including 39 males (92.9%) and 3 females (7.1%) with a mean age of 35.81 years (Range: 17-75 years) presented with segmental fracture of femur. Right lower limb was involved in 25 patients (59.52%) and left was involved in 17 patients (40.48%). The mean duration for union of the proximal fracture (18.76 ± 8.2 weeks) was lesser than the distal (22 ± 10.87 weeks). Though the length of the segments had no significant association with the time taken for fracture union, the comminution of the intermediate segment and prior application of external fixator had a significant effect on it. Presence of other long bone fractures had a significant association with proximal fracture delayed union (p = 0.035). Delayed union was also higher in patients with comminution of intermediate segment and with short distal segment, though no significant association was found.

CONCLUSION

Despite impeding factors, segmental fractures of shaft of femur managed by interlocking nailing gives excellent results when adequate consideration to the intercalary segment is given and timely management of complications are done.