Abstract
Purpose
To underline the feasibility of achieving early weight bearing in patients with distal end-segment femur fractures (AO/OTA 33) treated with retrograde intramedullary nailing and supplemental plate or lag screws in the absence of C-arm.
Methods
41 distal end-segment femur fractures (DFFs) included in the study were treated with SIGN nails with or without a side plate in a center that lacked intraoperative fluoroscopy and fracture table. A medial or lateral para-patellar incision was used for fracture reduction, nail insertion and side plate placement. Follow-ups were done at six weeks, 12 weeks, and six months post-operatively.
Results
Distal end-segment fractures constituted 13.2% of all femur fractures treated. The patients’ mean age and range were 49.6 and 23–83 years respectively. They were mostly injured in road traffic accidents. 27 were daily-income earners. By the 12th week post-operatively, 82.1% of them could flex their knee beyond 90°, all of them could bear weight fully, and 71.8% could squat & smile.
Conclusion
The study highlighted the procedure for retrograde nailing of DFFs in a setting without the requisite facilities for minimally-invasive surgeries. The findings demonstrated the feasibility of achieving an expedited weight bearing for the predominantly daily-income-earning victims to ensure early return to work and poverty reduction. While the small sample size is a limitation, the study does provide information that could serve as a basis for future randomized controlled trials in low-resource settings.
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Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors are deeply grateful to SIGN Fracture Care International and its founder and president, Dr. Lewis G. Zirkle for the free donation of SIGN implants and training without which this study would not have been possible.
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No funding was received to assist with the preparation of this manuscript.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by SAA, IOA, and AIA. The first draft of the manuscript was written by SAA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
The study protocols were approved by the Bowen University Teaching Hospital Research Ethics Committee. All patients gave informed consent to be included in the study and have their data published. All procedures were conducted per ethical standards.
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Adesina, S.A., Amole, I.O., Adefokun, I.G. et al. Retrograde intramedullary nailing with supplemental plate and lag screws allows early weight bearing following distal end-segment femur fractures (AO/OTA 33) in a low-resource setting. Eur J Orthop Surg Traumatol 34, 1519–1527 (2024). https://doi.org/10.1007/s00590-023-03828-z
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DOI: https://doi.org/10.1007/s00590-023-03828-z