Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania

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Assessment of clinical and radiographic outcomes following retrograde versus antegrade nailing of infraisthmic femoral shaft fractures without the use of intraoperative fluoroscopy in Tanzania


JournalOTA International
Article typeJournal research article – Clinical research
Publication date – Mar – 2021
Authors – von Kaeppler Ericka P., Donnelley Claire A. , Roberts Heather J., Eliezer Edmund N, Haonga Billy T, Morshed Saam , Shearer David
KeywordsFemoral shaft fractures, Health-related quality of life (HRQOL), infraisthmic diaphyseal
Open access – Yes
SpecialityTrauma and orthopaedic surgery, Trauma surgery
World region Eastern Africa
Country: Tanzania
Language – English
Submitted to the One Surgery Index on April 1, 2021 at 11:23 pm
Abstract:

Objectives:
To compare clinical and radiographic outcomes following antegrade versus retrograde intramedullary nailing of infraisthmic femoral shaft fractures.

Design:
Secondary analysis of prospective cohort study.

Setting:
Tertiary hospital in Tanzania.

Participants:
Adult patients with infraisthmic diaphyseal femur fractures.

Intervention:
Antegrade or retrograde SIGN intramedullary nail.

Outcomes:
Health-related quality of life (HRQOL), radiographic healing, knee range of motion, pain, and alignment (defined as less than or equal to 5 degrees of angular deformity in both coronal and sagittal planes) assessed at 6, 12, 24, and 52 weeks postoperatively.

Results:
Of 160 included patients, 141 (88.1%) had 1-year follow-up and were included in analyses: 42 (29.8%) antegrade, 99 (70.2%) retrograde. Antegrade-nailed patients had more loss of coronal alignment (P = .026), but less knee pain at 6 months (P = .017) and increased knee flexion at 6 weeks (P = .021). There were no significant differences in reoperations, HRQOL, hip pain, knee extension, radiographic healing, or sagittal alignment.

Conclusions:
Antegrade nailing of infraisthmic femur fractures had higher incidence of alignment loss, but no detectable differences in HRQOL, pain, radiographic healing, or reoperation. Retrograde nailing was associated with increased knee pain and decreased knee range of motion at early time points, but this dissipated by 1 year. To our knowledge, this is the first study to prospectively compare outcomes over 1 year in patients treated with antegrade versus retrograde SIGN intramedullary nailing of infraisthmic femur fractures.

OSI Number – 20992

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