Conference abstract
Retrograde femoral intramedullary nailing in low income setting (techniques and outcome)
Pan African Medical Journal - Conference Proceedings. 2023:17(65).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.65.1836
Archived on: 04 Jun 2023
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Keywords: Distal femur fractures, distal diaphyseal fracture fixation, retrograde intramedullary nailing
Poster
Retrograde femoral intramedullary nailing in low income setting (techniques and outcome)
Mosoh Franklin1, Handy Eone Daniel1,&, Mohamadou G1, Ngo Yamben MA1
1Department of Surgery and Specialties, University of Yaoundé 1, Yaoundé, Cameroon
&Corresponding author
Introduction: the epidemiological profile of fractures involving the distal femur and distal diaphyseal femur reveals an increased and rising prevalence of these fracture lesion in both old and young. Retrograde intramedullary fixation is a modern-day fixation technique whose mode of utilization takes into consideration the complications related to the use of old fixation implants and techniques of these lesions. The limitation of complete standardized material resources as well as the sluggishness to embrace these standards warrants the need for update on the adapted practice (techniques, Indication, and results) of retrograde intramedullary nailing in our setting.
Methods: we carried out a 36-monthly prospective descriptive study with some analytical aspects on 24 patients who benefited from retrograde intramedullary nailing for closed femoral fractures over a period of 36 months. Fractures were classified using anatomically into distal femoral and distal diaphyseal and further, each using the AO classification system. We systematically used short titanium nails of length range 150cm to 300cm and diameter 10cm and 11cm, of mark IRENE. The mini-arthrotomy approach and the open approaches (lateral extensile and parapatellar arthrotomy plus lateral approach for reduction) were both separately used. The ROM and HSS scores were used to analyze functional outcomes at the latest visit with regard to the study period. Bone union was evaluated from consecutive X-rays and clinical pictures and the period was noted.
Results: the mean follow-up period was 62±37.1 (16-144) weeks, and we had 12(50%) patients with distal femoral fractures. Male to female ratio was 1.4:1. The mean age was 47.5±16.8 years. High energy injury mechanisms accounted for 20(83.3%) of patients. Retrograde nails were indicated in 10(83.3%) cases of AO type A and 2(16.7%) cases of AO type C1 and C2 of DF fractures. The mini-arthrotomy approach was used in14 done in14(58.3%),7(29.2%)of extensile approach and 3(12.5%) parapatellar arthrotomy. Bone union was obtained in19(79.2%), delayed union in 04(16.7%) and non-union in 01(4.2%). Mean ROM,102.9±23.1(50130) degrees. The HSS score was good to excellent in 20 (83.3%). There was a significant correlation (p-value=0.05) between HSS score and type of approach, as well as HSS score and age range, with a higher score in younger patients and patients who underwent a miniarthrotomy. Similarly, the ROM was significantly higher in distal diaphysis fractures than DF.13(37.5%) of patients had Knee pain, 02 patients with distal screw loosening, 01 patient with intra-articular impingement by nail and 01 patient had a valgus mal alignment > 5degrees.
Conclusion: results of retrograde intramedullary nailing in our milieu remain satisfactory in spite of the adaptations with open approaches, hence the need for mastery of such techniques as well as the standard techniques and to vulgarize this practice in our context.
Retrograde femoral intramedullary nailing in low income setting (techniques and outcome)
Mosoh Franklin1, Handy Eone Daniel1,&, Mohamadou G1, Ngo Yamben MA1
1Department of Surgery and Specialties, University of Yaoundé 1, Yaoundé, Cameroon
&Corresponding author
Introduction: the epidemiological profile of fractures involving the distal femur and distal diaphyseal femur reveals an increased and rising prevalence of these fracture lesion in both old and young. Retrograde intramedullary fixation is a modern-day fixation technique whose mode of utilization takes into consideration the complications related to the use of old fixation implants and techniques of these lesions. The limitation of complete standardized material resources as well as the sluggishness to embrace these standards warrants the need for update on the adapted practice (techniques, Indication, and results) of retrograde intramedullary nailing in our setting.
Methods: we carried out a 36-monthly prospective descriptive study with some analytical aspects on 24 patients who benefited from retrograde intramedullary nailing for closed femoral fractures over a period of 36 months. Fractures were classified using anatomically into distal femoral and distal diaphyseal and further, each using the AO classification system. We systematically used short titanium nails of length range 150cm to 300cm and diameter 10cm and 11cm, of mark IRENE. The mini-arthrotomy approach and the open approaches (lateral extensile and parapatellar arthrotomy plus lateral approach for reduction) were both separately used. The ROM and HSS scores were used to analyze functional outcomes at the latest visit with regard to the study period. Bone union was evaluated from consecutive X-rays and clinical pictures and the period was noted.
Results: the mean follow-up period was 62±37.1 (16-144) weeks, and we had 12(50%) patients with distal femoral fractures. Male to female ratio was 1.4:1. The mean age was 47.5±16.8 years. High energy injury mechanisms accounted for 20(83.3%) of patients. Retrograde nails were indicated in 10(83.3%) cases of AO type A and 2(16.7%) cases of AO type C1 and C2 of DF fractures. The mini-arthrotomy approach was used in14 done in14(58.3%),7(29.2%)of extensile approach and 3(12.5%) parapatellar arthrotomy. Bone union was obtained in19(79.2%), delayed union in 04(16.7%) and non-union in 01(4.2%). Mean ROM,102.9±23.1(50130) degrees. The HSS score was good to excellent in 20 (83.3%). There was a significant correlation (p-value=0.05) between HSS score and type of approach, as well as HSS score and age range, with a higher score in younger patients and patients who underwent a miniarthrotomy. Similarly, the ROM was significantly higher in distal diaphysis fractures than DF.13(37.5%) of patients had Knee pain, 02 patients with distal screw loosening, 01 patient with intra-articular impingement by nail and 01 patient had a valgus mal alignment > 5degrees.
Conclusion: results of retrograde intramedullary nailing in our milieu remain satisfactory in spite of the adaptations with open approaches, hence the need for mastery of such techniques as well as the standard techniques and to vulgarize this practice in our context.
