Focus on interlocking intramedullary nailing without fluoroscopy in resource-limited settings: strategies, outcomes, and outlook

Bombah, Freddy Mertens; Lékina, Florent Anicet; Eone, Daniel Handy; Dakouré, Patrick Wendpouiré Hamed; Sermon, An

doi:10.1007/s00264-021-05208-w

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Surgical timing, often a critical point of discussion, did not emerge as a predictor for mortality in our cohort. There are case series that show optimal results of intramedullary fixation with closed reduction without intraoperative imaging, reducing operative time [ 27 , 28 ]. Our results here diverge from Streubel et al [ 7 ] and Myers et al [ 11 ], this disparity can be attributed to diverse patient populations, institutional practices, or even the relative health of the cohorts studied.…”

Section: Discussionmentioning

confidence: 99%

Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres

Delgadillo,

Rojas Lievano,

Olarte

2024

International Orthopaedics (SICOT)

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Purpose This study aimed to estimate the mortality at various post-operative intervals and explore influential variables for these outcomes in elderly patients with distal femur fractures (DFF). Methods A retrospective observational study was conducted across two tertiary care institutions, between 2014 and 2020. The primary outcomes were mortality rates at 30-day, six month, and one year post-surgery. Secondary outcomes included 1-year readmission and reintervention rates along with their correlated complications. Results A total of 37 DFF in 35 patients was analyzed; average age was 83.6 years (range, 65–98 years). The overall mortality rate at a maximum follow-up of 8.8 years was 74% (26/35 patients). The median survival time was 3.2 years and the survival probability at five years was 27% (95% confidence interval [CI], 13 to 43%). Mortality rates at 30 days, six months, and one year after surgery were 8.6% (3 patients), 23% (8 patients), and 34% (12 patients), respectively. Overall mortality rate was 64% (15/24 patients) for native distal femur fractures, and 92% (13/14 patients) for periprosthetic fractures (p = 0.109). Patients older than 85 years and male gender were identified as risk factors for mortality within the first year post-operatively. Conclusion Elderly fractures have a high mortality at eight years of follow-up. Mortality at one year was much higher than in other studies of the same nature. We did not find statistically significant differences when comparing native bone fractures with periprosthetic fractures. Factors that impact mortality were being a man, advanced age, elevated index comorbidity, and dementia. There is no relationship between the time to be taken to the surgical procedure and mortality results.

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Section: Discussionmentioning

confidence: 99%

Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres

Delgadillo,

Rojas Lievano,

Olarte

2024

International Orthopaedics (SICOT)

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“…In femoral fractures, the use of IMN with image intensifier is the standard technique. However, in LIMC where the image intensifier is not available in all scenarios, the locking targeting device in the SSN® is designed for use without an image intensifier or the availability of the SFN® that does not require distal locking screws is helpful in the treatment of long bone fractures in LIMCs [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

Perdomo-Lizarraga,

Andrade-Arellano,

Necchi

et al. 2024

International Orthopaedics (SICOT)

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Purpose Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach. Material and Methods This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated. Results A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57). Conclusions Both options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.

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“…In this government hospital, a large number of pa ents are a racted because of government subsidies, and the low cost of surgical procedures with sa sfactory results. Surgical techniques with ps and tricks step by step-for ORIF with ILIMN in sha femur Various surgical techniques have been developed for interlocking intramedullary nailing for the management of fracture of sha of femoral according to their experience of the exper se on the different situa ons in opera on theater and they gradually change in techniques, open reduc on techniques, locking bold placement, without C-arm fluoroscopy, without trac on table are a limited study in [5][6][7][8][9] previous published. Here our surgical team also tried some techniques along with previous published techniques.…”

Section: Methodsmentioning

confidence: 99%

Outcome of Open Reduction and Internal Fixation with Interlocking Intra-Medullary Nail in the Treatment of Fracture of Shaft of Femur without Fluoroscopy

Sah,

Yadav,

Shrivastav

et al. 2023

Birat J. Health Sci.

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Introduction: Femoral shaft fractures are among the common fractures generally managed by close reduction and internal fixation (CRIF) with interlocking intramedullary nailing (ILIMN) as the nail provides the rotational as well as longitudinal stability along with good clinical and functional outcomes but requiring fluoroscopy guidance. Also, in delayed cases, the close reduction might not be possible intimidating the need of open reduction. Objective: To assess the clinical outcome of the treatment from Open Reduction and Internal Fixation (ORIF) technique as well as placement tricks of locking screws in the absence of a traction table and fluoroscopy. Methodology: Fourteen cases of close femur fractures with transverse and oblique type in the middle 1/3 shaft coming to Koshi Hospital, Nepal, from June 2019 to December 2021 were included in this study. All patients were treated with ORIF with ILIMN technique without the use of a traction table and fluoroscopy. Data collection included demography, mechanism of injury, mobilization time, union rate, infection, and complication. The study was also designed to evaluate the method of our technique which could be helpful in case of dysfunction of fluoroscopy during intra-operative of CRIF in a resource-limited setting. Results: The average age of patients was 39.86±14.93, the average hospital stay duration was 12 ± 8.60 days, full weight-bearing walking was around 11.64 ± 3.15 weeks and the average union time was observed to be 14.54 ± 3.36 weeks. Conclusion: This technique was successful with an efficient duration of the surgery and satisfactory results in early mobilization and fracture union time. Thus, concluding it to be a safe procedure in situations like old fracture (more than 3 weeks), pelvic injury with urethral injury, lack of traction table, and dysfunction of fluoroscopy.

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Focus on interlocking intramedullary nailing without fluoroscopy in resource-limited settings: strategies, outcomes, and outlook

Cited by 3 publications

References 18 publications

Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres

Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres

Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?

Outcome of Open Reduction and Internal Fixation with Interlocking Intra-Medullary Nail in the Treatment of Fracture of Shaft of Femur without Fluoroscopy

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