Etiology, morphology, treatment modalities and early outcomes of femoral shaft fractures in adult patients at Moi Teaching and Referral Hospital, Eldoret

Abstract

Background: The femur is the longest, strongest weightbearing bone in the lower limb. Femur shaft fractures (FSF) arise from variable causes of trauma and assume variable morphology. They are managed through different treatment modalities and their early outcomes also differ. There is paucity of published research information regarding the FSF in terms of the etiology, morphology, treatment modalities and early outcomes at Moi Teaching and Referral Hospital (MTRH), Eldoret. Objective: To determine the etiology, morphology, treatment modalities and early outcomes of FSF in adult patients seeking treatment at MTRH. Methods: This was prospective descriptive study involving adult patients with FSF carried out at MTRH orthopedics wards and outpatient fracture clinic. Informed consent was obtained before enrollment. Consecutive sampling was used. Data collection was via a researcher-administered questionnaire and radiological and clinical examination of the patients. Patients were followed up for three months and the outcomes assessed using the American Academy of Orthopedic Surgeons Lower Limb Questionnaire. Data was analyzed using standard software for statistical analysis system software (Version 9.1). Associations were assessed using Chi- Square and Fischer’s exact tests. A total of 137 patients with 149 FSF was recruited into the study. Results: Median age was 36 (IQR: 28, 53) years with a minimum and maximum of 18 and 81 years respectively. Recruited were 72 males and 65 females. Most of the FSF (64%) were due to Road Traffic Accidents (RTAs); falls 20 (15.0%); assault 16(12%); Sports 12 (9%). Up to 47% of the fractures were open type while 53% were closed. Middle 1/3 femur shaft was the commonest level of fracture at 53%. Intramedullary nailing was the commonest treatment modality at 79%. Outcomes were Good to Excellent at 92.7%, with a complication rate of 15.3% of which infection was the commonest at 28.6%. Conclusion: RTAs were the major cause of FSF. Most FSFs were closed with type AO 32 A being the commonest. Intramedullary nailing was the preferred treatment modality. Outcomes were predominantly Good to Excellent with a fairly low complication rate. Recommendations: The use of intramedullary nailing should be encouraged and upheld for FSF.