Effectiveness and complications of SIGN intramedullary interlocking nailing in the management of femoral and tibial fractures at Moi Teaching and Referral Hospital, Eldoret- Kenya: A retrospective study

Abstract

Background: Interlocking intramedullary nailing is the current state-of-the-art management of the shaft fractures of long bones. Objective: To assess the functional outcome of SIGN nailing of femoral and tibial fractures at Moi Teaching and Referral Hospital. Design: Retrospective analytical, study over a three year period from February 2005 to April 2008. Setting: Orthopaedic Department, Moi Teaching and Referral Hospital, Eldoret. Subjects: All patients with closed or Gustillo Grade I or II open tibial and/or femoral shaft fractures presenting at Moi Teaching and Referral Hospital, Eldoret. Results: Three hundred and eleven patients with tibial and/or femoral shaft fractures were treated at Moi Teaching and Referral Hospital of whom 245(78.8%) were males while 66(21.2%) were females. Total nails fixed were 329 and the oldest patient aged 100 years while the youngest was 13 years.Twelve (3.9%) of the total number of patients presented with ipsilateral fractures, 4(1.3%) had bilateral fractures, 4 (1.3%) had fractures of both the femur and tibia while 1(0.3%) patient had fractures of the femur and humerus. There were 300 closed fractures and 29 open fractures treated with intramedullary nailing. Road traffic accidents were the leading cause of injury. Other causes included falls, assault, gunshot, sports injuries, pathological fractures among others. Prophylactic antibiotics were used in 288 patients. One hundred and thirty four (43.1%) patients turned up for follow up during the same period. There were 23 cases of wound infection, 4(1.2%) broken nails, 6(1.8%) failed distal locking and 2(0.6%) fractures above the nail. Conclusion: Males were found to be more affected than females. Road traffic accidents are the leading causes of trauma. Loss of follow up is one of the major problems still encountered. SIGN intramedullary nailing was found to be the most effective method of fracture management with minimum complications.