Is mini-open intramedullary nailing an effective intervention for adult femoral diaphyseal fractures in odd hours? A prospective case-control functional outcome and radiation safety study.

Abstract

Closed intramedullary (IM) nailing among various modalities is one of the commonest sought out procedure in current practice for management of femoral-diaphyseal fractures (FDF) following trauma. However, it has some limitations like prolonged procedural duration, high radiation exposure and a steep learning curve. Therefore, with limited resources in odd hours and at a high patient turnover center where closed reduction can be a challenge, we adopted a modified mini-open technique which can overcome the limitations of closed reduction technique. To compare the closed IM nailing and mini-open technique in FDF in terms of radiation exposure, surgical duration, radiological and functional outcome. A total of 100 patients (118 femurs) with FDF (AO 32A1-B2) operated in odd-hours (20:00-06:00 hrs. GMT +5.30) with closed (Group I, n=62) or mini-open (Group II, n=56) IM nailing technique between September 2018 to December 2019 with a minimum follow up of 12 months were included in this study. The functional outcomes were measured using Thoresen scoring system and statistical analysis were performed using paired t-test and χ2 -test. The overall mean patient age was 33.5 years (18-74 years). The mean surgical duration, c-arm shoots for reduction and radiological union time were 71.5 minutes, 21 shoots and 16 weeks, respectively for group I and 47.5 minutes, 9.4 shoots and 18 weeks for group II. There was significant difference between the two groups in mean surgical duration (p<0.05) and c-arm shoots (p<0.05). However, there was no statistical significant difference between time for union, rate of union, functional results and incidence of superficial or deep infection between the two groups. In conclusion, mini-open technique is a safer alternative in patients with FDF at high-volume centers and in odd-hours when the available resources are limited.