Comparative Study of Management of Closed Comminuted Femoral Shaft Fractures with Closed Interlocking Intramedullary Nail and Open Reduction and Dynamic Compression Bridge Plating

Abstract

Fracture shaft of the femur are life-threatening injuries and can cause severe permanent disability. Nowadays die interlocking nailing is regarded as the operative technique of choice for fracture shaft of femur. However, the advantages and disadvantages have rarely been compared with plate osteosynthesis. This is prospective study to compare the two methods of treatments in terms of time to union, hospital slay (including readmission), wound infection, shortening of limb, delayed union, malunion, joint stiffness and implant failure. 54 patients, age (16 to 66) years, were treated by DCP (22), and interlocking nail (24). Eight patients were lost to follow up. The study was conducted in Services Hospital, Department of Orthopaedics and Ittefaq Hospital, Lahore, Pakistan from June 1996 to Dec 1997. Written consent was taken regarding the type of surgery to be performed. Open fractures of Gustilo Grade n or in, femoral shaft fractures associated with other fractures of the same femur, fractures in immature skeleton and segmental fracture were excluded. Winquist and Hansen classification was used to classify fracture comminution. Patients were alternately allocated. In the plating group, primary bone grafting was done in all cases. Time to union in nailing group was 16.43t2.48 weeks and in plating 19.88±3.46 weeks, p-value0.05. There were 2 deep infections in the plating group and none in nailing group. There was no shortening of limb in die plating group but 2 patients in the nailing group had shortening of 2 cms. Delayed union occurred in 2 patients in nailing group but 5 in plating group. One patient in the nailing group had external rotation of at least 10 degrees and none in plating group. Two patients in the nailing group had knee stiffness and 6 patients in me plating group. One patient in the nailing group had a broken interlocking screw 2 patients in the plating group had bent plates. Closed interlocking intramedullary nailing as a method of treating closed communited femoral shaft fracture is better than plating in terms of rate of postoperative complication including infection. Key Words: Comminuted fractures shaft of femur, static interlocking nailing and bridge plating.