Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi

Authors

  • Linda Chokotho Department of Surgery, College of Medicine, University of Malawi; Department of Clinical Medicine, University of Bergen, Bergen, Norway
  • Hao-Hua Wu Institute for Global Orthopedics and Traumatology, Orthopedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
  • David Shearer Institute for Global Orthopedics and Traumatology, Orthopedic Trauma Institute, University of California San Francisco, San Francisco, CA, USA
  • Brian C Lau Department of Orthopedic Surgery, Duke University Medical Centre, Durham, NC, USA
  • Nyengo Mkandawire Department of Surgery, College of Medicine, University of Malawi; School of Medicine, Flinders University, Adelaide, Australia
  • Jan-Erik Gjertsen Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
  • Geir Hallan Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
  • Sven Young Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi

DOI:

https://doi.org/10.1080/17453674.2020.1794430

Abstract

Background and purpose — Intramedullary nailing (IMN) is underutilized in low-income countries (LICs) where skeletal traction (ST) remains the standard of care for femoral shaft fractures. This prospective study compared patient-reported quality of life and functional status after femoral shaft fractures treated with IMN or ST in Malawi.

Patients and methods — Adult patients with femoral shaft fractures managed by IMN or ST were enrolled prospectively from 6 hospitals. Quality of life and functional status were assessed using EQ-5D-3L, and the Short Musculoskeletal Function Assessment (SMFA) respectively. Patients were followed up at 6 weeks, 3, 6, and 12 months post-injury.

Results — Of 248 patients enrolled (85 IMN, 163 ST), 187 (75%) completed 1-year follow-up (55 IMN, 132 ST). 1 of 55 IMN cases had nonunion compared with 40 of 132 ST cases that failed treatment and converted to IMN (p < 0.001). Quality of life and SMFA Functional Index Scores were better for IMN than ST at 6 weeks, 3 and 6 months, but not at 1 year. At 6 months, 24 of 51 patients in the ST group had returned to work, compared with 26 of 37 in the IMN group (p = 0.02).

Interpretation — Treatment with IMN improved early quality of life and function and allowed patients to return to work earlier compared with treatment with ST. Approximately one-third of patients treated with ST failed treatment and were converted to IMN.

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Published

2020-07-23

How to Cite

Chokotho, L., Wu, H.-H., Shearer, D., Lau, B. C. ., Mkandawire, N., Gjertsen, J.-E., … Young, S. . (2020). Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi. Acta Orthopaedica, 91(6), 724–731. https://doi.org/10.1080/17453674.2020.1794430