PURPOSE: To review the treatment outcome of patients with neglected femoral shaft fractures. METHODS: Records of 22 men and 3 women aged 20 to 55 (mean, 36) years who underwent open interlocking nailing and bone grafting for neglected (2-month-old or more) closed femoral shaft fractures were reviewed. 21 had nonunion and 4 had malunion. All patients had deformed, shortened, and wasted lower limbs, with knee stiffness. The mean delay in presentation was 3 (range, 2-7) months. RESULTS: Patients were followed up for a mean of 18 (range, 14-30) months. The mean time for radiological union was 5 (range, 4-7) months. Three patients had delayed union (6 months or more) and underwent secondary procedures (dynamisation or bone marrow injection). None had non-union. All had some degree of shortening; in 3 it was >2 cm. None had neurological injury following acute gain in length. None had deep infections; 2 had superficial wound infections and 6 had pin tract infections. Mean knee flexion improved 50 (from 70 to 120) degrees and the mean extensor lag decreased 7 (from 15 to 8) degrees. After a mean of 18 weeks, 23 of the patients were able to return to their work. CONCLUSION: Open interlocking nailing and bone grafting coupled with aggressive rehabilitation can achieve acceptable results for patients with neglected femoral shaft fractures.
PURPOSE: To review the treatment outcome of patients with neglected femoral shaft fractures. METHODS: Records of 22 men and 3 women aged 20 to 55 (mean, 36) years who underwent open interlocking nailing and bone grafting for neglected (2-month-old or more) closed femoral shaft fractures were reviewed. 21 had nonunion and 4 had malunion. All patients had deformed, shortened, and wasted lower limbs, with knee stiffness. The mean delay in presentation was 3 (range, 2-7) months. RESULTS:Patients were followed up for a mean of 18 (range, 14-30) months. The mean time for radiological union was 5 (range, 4-7) months. Three patients had delayed union (6 months or more) and underwent secondary procedures (dynamisation or bone marrow injection). None had non-union. All had some degree of shortening; in 3 it was >2 cm. None had neurological injury following acute gain in length. None had deep infections; 2 had superficial wound infections and 6 had pin tract infections. Mean knee flexion improved 50 (from 70 to 120) degrees and the mean extensor lag decreased 7 (from 15 to 8) degrees. After a mean of 18 weeks, 23 of the patients were able to return to their work. CONCLUSION: Open interlocking nailing and bone grafting coupled with aggressive rehabilitation can achieve acceptable results for patients with neglected femoral shaft fractures.