Indications and outcome of Open Reduction and Internal Fixation of Long Bones in Benue State North Central Nigeria

Yongu WT; Amaefula T; Elachi IC; Mue DD; Songden ZD; Kortor JN

doi:10.52981/sjms.v9i1.1072

Yongu WT Benue State University Teaching Hospital Makurdi Benue State Nigeria
Amaefula T Niger Delta University Bayelsa State
Elachi IC Benue State University Teaching Hospital Makurdi Benue State Nigeria
Mue DD Benue State University Teaching Hospital Makurdi Benue State Nigeria
Songden ZD University of Abuja Teaching Hospital Gwagwalada
Kortor JN Benue State University Teaching Hospital Makurdi Benue State Nigeria

DOI: https://doi.org/10.52981/sjms.v9i1.1072

Keywords: Plates and screws, nails, implant closed fracture, fracture union, Benue

Abstract

Background: Open reduction and internal fixation (ORIF) is a well-established surgical treatment of fractures worldwide. However, the indications and modes of stabilization of long bone fractures vary and are evolving .The general trend now is towards fixation with locked intramedullary nail (i.m nail) rather than plate and screws.
Objective: To identify the common indications for ORIF in our environment, the implant commonly used and ascertain the outcome of such fixations.
Materials and Methods: A four year retrospective review of all the patients who had ORIF at NKST Rehabilitation Hospital Mkar Benue State between January 2007 and December 2010 was done. The data obtained included the age, sex, diagnosis, implant used (plate and screws or i.m nail), outcome (united or failed implant), complications and bones involved. All
case notes with incomplete data were excluded from the study. Follow up was for 24 months. The data was analyzed using SPSS 16.
Results: There were 361 ORIF done on 355 patients, 245(66.4%) males and 124(33.6%) females giving a male to female ratio of 2:1. The age range was 3 to 82 years with mean age of 36.4 years (SD 14.7). The indications for ORIF were closed fractures 187(50.7%), Nonunion 103(27.9%), Malunion 57 (15.4%), Failed implant 13(3.5%), Delayed union 4(1.1%), open fracture 4(1.1%), and congenital pseudoarthrosis of the tibia 1(0.3%). The commonest bone involved was the femur 205(55.6%) followed by the tibia and fibula 78(21.1%) and humerus 58(15.7%) then others 28(7.6%). Plate and screws were used in 354(95.1%), i.m nail in 15(4.1%). The fractures that united were 357(96.7%), 12(10 plates and screws, 2 i.m nails) (3.3%) had failed implant. Infection was documented in 8(2.2%), joint stiffness in 4(1.1%) and limb length discrepancy in 4(1.1%).
Conclusion: The study shows that plates and screws are the commonest implants used at NKST Rehabilitation Hospital. Closed fractures are the commonest mode of presentation, and the femur is the commonest bone fractured that requires ORIF. The fracture union rate is also acceptable but might be better if intramedullary nails are used where indicated

References

1. C. C Wu Treatment of Long-Bone Fractures, Malunions, and Nonunions: Experience at Chang Gung Memorial Hospital,Taoyuan, Taiwan Chang Gung Med J 2006:29; 347-3563.
2. Allen WC, Piotrowski G, Burstein AH, Frankel VH.Biomechanical principles of intramedullary fixation.ClinOrthop 1968;60:13-20.
3. Tarr RR, Wiss DA. The mechanics and biology of intramedullary fixation.ClinOrthop 1986;212:10-7.
4. Inhofe PD. Biomechanical considerations in intramedullary fixation of lower-extremity fracture. Orthop Rev 1992;21:945-52.
5. Brunner CF, Weber BG. Besondere Osteosynthesetechniken 1981: Berlin ; Springer.
6. Wu CC, Shih CH, Lee ZL. Subtrochanteric fractures treatedwith interlocking nailing. J Trauma 1991;31:326-337
7. Wu CC, Shih CH, Ueng WN, Chen JY. Treatment of segmental femoral shaft fractures. ClinOrthop1993;287:224-30.
8. Wu CC. Femoral reconstruction. Chang Gung Med J2001;24:756-67.
9. Wu CC, Shih CH, Chen YJ, Shih PY. Conservative treatment of humeral shaft fractures- -emphasis on the value of functional brace treatment. J OrthopSurg (R.O.C.)1992;9:61-70.
10. Van Der Schoot DKE, Den Outer AJ, Bode PJ, ObermannWR, Van Vugt AB. Degenerative change at the knee and ankle related to malunion of tibial fractures: 15-year follow-up of 88 patients. J Bone Joint Surg [Br]1996;78:722-5.
11. Karlstrom G, Olerud S. Fractures of the tibial shaft—acritical evaluation of treatment alternatives. ClinOrthop1974;105:82-111.
12. Klaue K, Fengels I, Perren SM. Long-term effects of plate osteosynthesis: comparison of four different plates. Injury 2000;31 Suppl. 2:S-62.
13. Krettek C, Haas N, Tscherne H. The role of supplemental lag-screw fixation for open fractures of the tibial shaft treated with external fixation. J Bone Joint Surg [Am] 1991;73:893 -897.
14. H. Clarke, M. Green. Materials. In: M. Green,L.D.M. Nokes, eds. Engineering Theory in Orthopaedics: An introduction. Ellis Horwood: Chichester. 1988; 24-5.
15. Ogbemudia ,AO ,Umebese FA. Implant failure in osteosynthesis of fracture of long bones. CMS UNIBEN JMBR 2006; 5(2): 75-78