Stephen Adesope Adesina1,2, Samuel Uwale Eyasan3,4, Isaac Olusayo Amole5,6, Olufemi Timothy Awotunde5,6, Akinsola Idowu Akinwumi7, Adewumi Ojeniyi Durodola5,6, Innocent Chiedu Ikem8. 1. Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria. stephen.adesina@bowen.edu.ng. 2. Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria. stephen.adesina@bowen.edu.ng. 3. Department Surgery, Bowen University, Iwo, Osun State, Nigeria. 4. Department Surgery, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria. 5. Department of Family Medicine, Bowen University , Iwo, Osun State, Nigeria. 6. Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria. 7. Department of Family Medicine, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria. 8. Department of Orthopaedic Surgery and Traumatology, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
Abstract
PURPOSE: Early closed reduction and locked intramedullary (IM) nailing has become the standard treatment for diaphyseal long bone fractures in high income countries. The low and middle income countries (LMICs) are still lagging behind in transiting from open surgical reduction and non-operative modalities to closed reduction due to lack of requisite equipment. However, some surgeons in LMICs are beginning to achieve closed reduction even without the equipment. METHODS: A prospective descriptive study was done on a total of 251 fresh diaphyseal fractures of the humerus, femur and tibia fixed with a locked nail over a 5½-year period. The fractures were grouped into those that had open reduction, closed reduction or reduction with a finger. RESULTS: Closed reduction was done for 135 (53.8%) fractures belonging to 123 patients. The mean and range of the patients' ages were 41.33 and 13-81 years, respectively. Males constituted 69.9% and mostly (48%) sustained fractures in motorcycle accident. There was a significant negative association between closed reduction and fracture-to-surgery interval (p < 0.001). Closed reduction also had positive associations with: (i) humerus and tibia fractures (p < 0.001), (ii) middle, distal and segmental fractures (p = 0.025), (iii) retrograde approach to femur fracture nailing (p < 0.001), and (iv) wedge or multifragmentary type femur fractures (p = 0.005). CONCLUSION: With constant practice, it is possible to achieve closed reduction of many fresh diaphyseal long bone fractures in spite of the limitations imposed on surgeons in LMICs by poor health systems and grossly inadequate fracture care facilities.
PURPOSE: Early closed reduction and locked intramedullary (IM) nailing has become the standard treatment for diaphyseal long bone fractures in high income countries. The low and middle income countries (LMICs) are still lagging behind in transiting from open surgical reduction and non-operative modalities to closed reduction due to lack of requisite equipment. However, some surgeons in LMICs are beginning to achieve closed reduction even without the equipment. METHODS: A prospective descriptive study was done on a total of 251 fresh diaphyseal fractures of the humerus, femur and tibia fixed with a locked nail over a 5½-year period. The fractures were grouped into those that had open reduction, closed reduction or reduction with a finger. RESULTS: Closed reduction was done for 135 (53.8%) fractures belonging to 123 patients. The mean and range of the patients' ages were 41.33 and 13-81 years, respectively. Males constituted 69.9% and mostly (48%) sustained fractures in motorcycle accident. There was a significant negative association between closed reduction and fracture-to-surgery interval (p < 0.001). Closed reduction also had positive associations with: (i) humerus and tibia fractures (p < 0.001), (ii) middle, distal and segmental fractures (p = 0.025), (iii) retrograde approach to femur fracture nailing (p < 0.001), and (iv) wedge or multifragmentary type femur fractures (p = 0.005). CONCLUSION: With constant practice, it is possible to achieve closed reduction of many fresh diaphyseal long bone fractures in spite of the limitations imposed on surgeons in LMICs by poor health systems and grossly inadequate fracture care facilities.
Authors: Amir Matityahu; Iain Elliott; Meir Marmor; Amber Caldwell; Richard Coughlin; Richard A Gosselin Journal: Bull World Health Organ Date: 2013-10-04 Impact factor: 9.408
Authors: Sven Young; Stein Atle Lie; Geir Hallan; Lewis G Zirkle; Lars B Engesaeter; Leif I Havelin Journal: Acta Orthop Date: 2011-11-09 Impact factor: 3.717