Author(s): Mark U. Pasion, M.D.; Lauro M. Abrahan Jr., M.D., F.P.C.S.; Lauro R. Bonifacio, M.D., F.P.C.S.; Manolito M. Flavier, M.D. Philippine Orthopedic Center
Closed intramedullary nailing is the standard treatment of femoral shaft fractures. This is done ideally using fracture table and C-arm. However, certain equipment is not always available in some hospitals especially in third world countries. The objective was to have an alternative technique to obtain closed method using X-ray or C-arm without fracture table even in a delayed setting.
Design: Descriptive Study
Patients with closed femoral shaft fracture admitted more than 3 days, distracted on balanced skeletal traction prior to closed antegrade intramedullary nailing with static locked from July 2008 to October 2010. Surgery was done in lateral decubitus position on a radioluscent table. Closed reduction was verified using X-ray or C-arm if available. Number of days prior to surgery, surgical time, intraoperative and postoperative complications, and cases of non union were recorded.
Ninety-six patients underwent closed nailing without fracture table; 78 were reduced via closed method, 44 in Group A (X-ray) and 34 in Group B (Image intensifier). Nine on each group failed via closed method and were opened. Average time was 139 min for Group A and 132 min for Group B. Average days prior to surgery was 18 days for Group A and 17 days for Group B; 3 patients in Group A and 4 in group B had valgus angulation, 1 posterior angulation noted in group B. Malrotation, reamer breakage inside the isthmus, and surgical site infection noted in Group A; no cases of nonunion in both groups.
Closed antegrade intramedullary nailing without fracture table using X-ray or C-arm for verification of reduction can be feasible. Closed reduction helps us to achieve the biological healing of a fracture even in cases that are delayed as a result of unavoidable circumstances especially in a setting where facilities are limited. The most important factor prior to closed nailing is adequate preoperative traction
Key words: closed antegrade intramedullary nailing, femoral shaft, skeletal traction, image intensifier, fracture table