TY - JOUR AU - Chokotho, Linda AU - Wu, Hao-Hua AU - Shearer, David AU - Lau, Brian C AU - Mkandawire, Nyengo AU - Gjertsen, Jan-Erik AU - Hallan, Geir AU - Young, Sven PY - 2020/07/23 Y2 - 2024/03/28 TI - 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 JF - Acta Orthopaedica JA - ActaO VL - 91 IS - 6 SE - Articles DO - 10.1080/17453674.2020.1794430 UR - https://actaorthop.org/actao/article/view/812 SP - 724–731 AB - <p><strong>Background and purpose —</strong> Intramedullary nailing&nbsp;(IMN) is underutilized in low-income countries (LICs)&nbsp;where skeletal traction (ST) remains the standard of care for&nbsp;femoral shaft fractures. This prospective study compared&nbsp;patient-reported quality of life and functional status after&nbsp;femoral shaft fractures treated with IMN or ST in Malawi.</p><p><strong>Patients and methods —</strong> Adult patients with femoral&nbsp;shaft fractures managed by IMN or ST were enrolled prospectively from 6 hospitals. Quality of life and functional&nbsp;status were assessed using EQ-5D-3L, and the Short Musculoskeletal Function Assessment (SMFA) respectively.&nbsp;Patients were followed up at 6 weeks, 3, 6, and 12 months&nbsp;post-injury.</p><p><strong>Results —</strong> Of 248 patients enrolled (85 IMN, 163 ST),&nbsp;187 (75%) completed 1-year follow-up (55 IMN, 132 ST).&nbsp;1 of 55 IMN cases had nonunion compared with 40 of 132&nbsp;ST cases that failed treatment and converted to IMN (p &lt;&nbsp;0.001). Quality of life and SMFA Functional Index Scores&nbsp;were better for IMN than ST at 6 weeks, 3 and 6 months, but&nbsp;not at 1 year. At 6 months, 24 of 51 patients in the ST group&nbsp;had returned to work, compared with 26 of 37 in the IMN&nbsp;group (p = 0.02).</p><p><strong>Interpretation —</strong> Treatment with IMN improved early&nbsp;quality of life and function and allowed patients to return&nbsp;to work earlier compared with treatment with ST. Approximately one-third of patients treated with ST failed treatment&nbsp;and were converted to IMN.</p> ER -