Evaluation of results of interlocking nails in femur fractures due to high velocity gunshot injuries.

BACKGROUND Femoral shaft fractures are common in adult population due to vulnerability to road traffic accident and firearm injuries. There are various treatment modalities to treat the femur shaft fracture, i.e., Plating & screws, Intramedullary nailing, External fixator and Interlocking nails. Comminuted fractures due to gun shot injuries are a challenging problem for orthopaedic surgeons. The objective of this study is to evaluate the role of interlocking nailing in the management of femoral fractures due to high velocity gunshot injuries. METHODS This descriptive study was conducted on 68 patients at Orthopaedic unit Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from March 2002 to March 2004. The patients of each gender from age fifteen years onward having femoral shaft fracture due to high velocity gunshot injuries who had not previous surgical intervention were included in the study. The exclusion criteria were intertrochanteric, supracondylar femoral fractures and those who failed the follow-up. All the patients were treated with close or open interlocking nails. The outcome measures were graded excellent, good and poor according to radiological and clinical results. Follow-up was for eighteen months and in some cases up to thirty months. RESULTS Out of 68 patients 64 (94.12%) were male and 4 (5.88%) were female patients. The age range was from 15 to 65 years (average age of twenty nine years. The close interlocking nails were done in 64 patients (94.12%) and open interlocking nails were done in 4 patients (5.88%). The static interlocking nailing was performed in 58 patients (85.29%) while dynamic interlocking nailing was performed in 10 patients (14.71%). Knee flexion contracture in 5 cases (7.35%) and limb shortening of less than 2 Cm in 2 patients (2.94%). Non-union were in 4 cases (5.88%). Excellent results were in 42 patients (61.76%), good in 18 patients (26.47%) and poor in 8 patients (11.77%). CONCLUSION Interlocking nailing is one of the best options for the management of femoral shaft fractures due to high velocity gunshot injuries.