Peculiarities of Locked Intramedullary Nailing in A Deprived Setting

Abstract

Introduction: Diaphyseal fractures of the femur and tibia are common worldwide with an increased incidence in lowand middle-income countries and are an immense economic burden on the populace. Locked intramedullary nailing is not readily available. We explore the challenges of starting this kind of procedure in a developing country setting. Methods: We study the first 45 consecutive cases of locked intramedullary nailing of the femur and tibia in the Cape Coast Teaching Hospital of the Central Region of Ghana from the period of 2016 to 2019. Results: There were 29 Males and 16 Females with a mean age of 39.8 years and with 76% being in the informal sector of the economy. Road traffic accidents were the commonest cause of injury accounting for 68.9% of fractures. There were 24 femur and 21 Tibia fractures with 51%, 16% and 33% being type A, B and C fractures respectively. Most patients presented within 24 hours of injury and the average waiting time before surgery was 6.1 days. All cases were done via ante grade nailing with an average operating time of 199 minutes for the femur and 147 minutes for the tibia. Average time on admission before discharge was 12.5 days. Conclusion: It is possible to consistently perform locked IM nailing for femur and Tibia diaphyseal fractures even in deprived environments but the surgical teams will require adequate training in the use of specialized equipment and health systems must provide for funding for orthopaedic instrumentation and implants so that these procedures can be undertaken in a timely fashion avoiding complications