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.
