Research Article
Volume 12 Issue 4 - 2021
Outcome of Femoral Fractures Treated with External Fixators in the Douala General Hospital: A Referral Hospital in a Poor Resource Setting in Africa
Fokam Pius1*, Nwagbara IC2, Nana C Theophile1, Mbachan T1, Palle JN1 and Ngowe Ngowe M3
1Faculty of Health Sciences, University of Buea, Buea, Cameroon
2College of Medicine, Imo State University, Owerri, Nigeria
3Faculty of Biomedical and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
*Corresponding Author: Fokam Pius, Faculty of Health Sciences, University of Buea, Buea, Cameroon.
Received: February 15, 2021; Published: March 30, 2021




Abstract

Background: The femur is the most robust and the longest bone in the body. It is a weight bearing bone and when fractured requires a strong and stable fixation. Intramedullary nailing is the best treatment option however other options also give successful results. External fixator has been used as temporary method especially in polytraumatised patients and open fractures. In our environment where secondary procedure is not very feasible because of limited resources, external fixators have been used as a definitive treatment with satisfactory outcome.

Objective: To study the outcome of patients with femoral fractures treated with external fixator.

Materials and Methods: Files of patients with femoral fractures treated with external fixators within a period of 10 years (January 2008 - December 2017) were retrieved from the surgical unit of Douala General Hospital. Standard definition of operational terms like fracture union, nonunion and malunion were used. The data obtained were age, gender, cause and type of fracture, associated injuries and complications. This data was analyzed using the statistical package for social sciences (SPSS) version 20.0. Pearson’s chi square test was used with a confidence interval (CI) of 95% at a p-value of < 0.05.

Results: We reviewed 97 files and exploited 86 with 87 fractures since there was a bilateral case. There were 62 (71.3%) open and 25 (28.7%) closed fractures. Most of the open fractures were Gustillo type II and IIIB (27.4%) each. Associated injuries included head injuries 23 (26%), radius/ulna fractures 12 (14.0%) and pelvic fractures 6 (7.0%). Average duration of surgery was 61 mins and average union time was 30 weeks. A total of 26 (30%) fractures consolidated uneventfully. Pin tract infection was the commonest complication with 37%. Most of it healed satisfactorily with dressings and antibiotics.

Conclusion: External fixators which are indicated for temporary fixation of femoral fractures have been found to be suitable in the definitive management of these fractures in low income settings and with favourable outcome. It is cost effective, fast to apply and with minimal soft tissue damage.

 

Keywords: Femur; Fracture; External Fixator; Outcome

References

  1. Halvorson JJ., et al. “Orthopaedic management in the polytrauma patient”. Frontiers of Medicine 3 (2012): 234-242.
  2. Li AB., et al. “Reamed versus unreamed intramedullary nailing for the treatment of femoral fractures: A meta-analysis of prospective randomized controlled trials”. Medicine29 (2016): e4248.
  3. Testa G., et al. “Definitive Treatment of Femoral Shaft Fractures: Comparison between Anterograde Intramedullary Nailing and Monoaxial External Fixation”. Journal of Clinical Medicine 8 (2019): 1119.
  4. Pairon P., et al. “Intramedullary nailing after external fixation of the femur and tibia: a review of advantages and limits”. The European Journal of Trauma and Emergency Surgery 1 (2015): 25-38.
  5. Fokam P., et al. “Paterns and presentations of femoral fractures treated with external fixator in general hospital Douala: a ten 10 year review”. African Journal of Integrated Health1 (2020): 14-19.
  6. Tuttle MS., et al. “Safety and efficacy of damage control external fixation versus early definitive stabilization for femoral shaft fractures in the multiple-injured patient”. Journal of Trauma 3 (2009): 602-605.
  7. Johnson KD., et al. “Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures”. Journal of Trauma 5 (1985): 375-384.
  8. Bone LB., et al. “Early versus delayed stabilization of femoral fractures. A prospective randomized study”. Journal of Bone and Joint Surgery American 3 (1989): 336-340.
  9. Zlowodzki M., et al. “External fixation of complex femoral shaft fractures”. International Orthopaedics 31 (2007): 409-413.
  10. Nahm NJ and Vallier HA. “Timing of definitive treatment of femoral shaft fractures in patients with multiple injuries: A systematic review of randomized and nonrandomized trials”. The Journal of Trauma and Acute Care Surgery 73 (2012): 1046-1063.
  11. Della Rocca GJ and Crist BD. “External fixation versus conversion to intramedullary nailing for definitive management of closed fractures of the femoral and tibial shaft”. The Journal of the American Academy of Orthopaedic Surgeons 10 (2006): S131-135.
  12. Babar IU. “External fixation in close comminuted femoral shaft fractures in adults”. Journal of the College of Physicians and Surgeons of Pakistan 9 (2004): 533-535.
  13. Pape HC., et al. “Timing of fixation of major fractures in blunt polytrauma: Role of conventional indicators in clinical decision making”. Journal of Orthopaedic Trauma 19 (2005): 551-562.
  14. Kubiak EN., et al. “Early weight bearing after lower extremity fractures in adults”. The Journal of the American Academy of Orthopaedic Surgeons 21 (2013): 727-738.
  15. Bonnevialle P., et al. “Single-plane external fixation of fresh fractures of the femur: critical analysis of 53 cases”. Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 5 (2005): 446-456.
  16. Scannell BP., et al. “Skeletal traction versus external fixation in the initial temporization of femoral shaft fractures in severely injured patients”. Journal of Trauma 68 (2010): 633-640.
  17. Oliveira VG., et al. “Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: Long-term outcomes of 45 cases”. The Journal of Trauma and Acute Care Surgery 72 (2012): E77-E80.
Citation: Fokam Pius., et al. “Outcome of Femoral Fractures Treated with External Fixators in the Douala General Hospital: A Referral Hospital in a Poor Resource Setting in Africa”. EC Orthopaedics 12.4 (2021): 54-61.

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