Closed reduction and locked intramedullary nailing of diaphyseal long bone fractures without intra-operative imaging and fracture table



Early closed reduction and locked intramedullary (IM) nailing has become the standard treatment for diaphyseal long bone fractures in high income countries. The low and middle income countries (LMICs) are still lagging behind in transiting from open surgical reduction and non-operative modalities to closed reduction due to lack of requisite equipment. However, some surgeons in LMICs are beginning to achieve closed reduction even without the equipment.


A prospective descriptive study was done on a total of 251 fresh diaphyseal fractures of the humerus, femur and tibia fixed with a locked nail over a 5½-year period. The fractures were grouped into those that had open reduction, closed reduction or reduction with a finger.


Closed reduction was done for 135 (53.8%) fractures belonging to 123 patients. The mean and range of the patients’ ages were 41.33 and 13–81 years, respectively. Males constituted 69.9% and mostly (48%) sustained fractures in motorcycle accident. There was a significant negative association between closed reduction and fracture-to-surgery interval (p < 0.001). Closed reduction also had positive associations with: (i) humerus and tibia fractures (p < 0.001), (ii) middle, distal and segmental fractures (p = 0.025), (iii) retrograde approach to femur fracture nailing (p < 0.001), and (iv) wedge or multifragmentary type femur fractures (p = 0.005).


With constant practice, it is possible to achieve closed reduction of many fresh diaphyseal long bone fractures in spite of the limitations imposed on surgeons in LMICs by poor health systems and grossly inadequate fracture care facilities.

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The authors are deeply grateful to SIGN Fracture Care International and its founder and president, Dr L. G. Zirkle for the free donation of SIGN implants and training without which this study would not have been possible.

Author information




This work was carried out in collaboration between all authors. Authors SAA, SUE and AIA, collected the data and wrote the protocol. Authors SAA, SUE and IOA designed the study. Authors IOA and SAA analyzed and interpreted the results. Authors SAA, IOA, OTA and SUE wrote the first draft of the manuscript. Authors ICI, OTA and SUE revised the manuscript critically for important intellectual content. Authors SUE, IOA and OTA searched for the literatures. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Stephen Adesope Adesina.

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Ethics approval and consent to participate

The study was approved by the Institutional Review Board of Bowen University Teaching

Hospital, Ogbomoso, Oyo State Nigeria. All patients gave informed consent to be included in the study.

Consent for publication

All patients approved of the authors’ intention to have the study published.

Conflict of interest

The authors acknowledge the fact that the implants used for the patients in this study were manufactured and freely donated by SIGN Fracture Care International.

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Adesina, S.A., Eyasan, S.U., Amole, I.O. et al. Closed reduction and locked intramedullary nailing of diaphyseal long bone fractures without intra-operative imaging and fracture table. International Orthopaedics (SICOT) (2021).

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  • Closed reduction
  • Intra-operative imaging
  • Locked intramedullary nail
  • Fracture table
  • Diaphyseal long bone fracture