Mini-Open Intra-Medullary Interlocking Nailing of Fracture Femur in a Tertiary Care Center; Our Experience

The number of studies confirmed the advantages of closed intramedullary nailing; however in certain situations, a mini-open technique may be alternative and advantageous. To evaluate the efficacy, convenience and outcomes of mini-open intramedullary nailing for fracture femur patients and to compare with the previously published reports. Thirty patients who had undergone mini-open interlocking nailing for femur fracture were evaluated for their outcomes. Evaluation included different aspects on range of movement at hip, knee, limb length discrepancy, delayed union, mal-union, non union, infection, implant failure and other complications like pain etc following surgery. The functional evaluation of the patients were done and graded accordingly which involved criteria like mal-alignment, rotation, shortening. Knee flexion and extensions too were evaluated, post-operatively. Results were graded as Excellent in 23 patients, Good in 3 patients and Fair in 4 patients. Three patients had restriction of flexion of the knee beyond 90 o at 16 weeks of follow up. Union occurred in 80% of the individuals in less than 19 weeks period. Infection was seen in our series in two patients (6.66%). Delayed union (defined as the presence of inadequate callus at 16 weeks post operatively) was seen in our series in four patients (13.33%). Sixteen percent patients had complications like implant failure or quadriceps wasting. A secondary procedure like dynamisation was required in 13% of the individuals. The mini-open reamed interlocking intramedullary nailing for fractures of the femoral shaft is an excellent modality of treatment. It appears that all fractures from the lesser trochanter to the femoral condyles such as transverse, comminuted, spiral, segmental, oblique fracture can be treated successfully by this technique. Moreover the fractures of the upper third and lower third which is difficult to reduce by closed technique can be treated better with open technique with lesser complications.