Factors Associated with Knee Range of Motion in Retrograde Traumatic Femur Shaft Nailing at Addis Ababa Burn Emergency and Trauma Hospital, Addis Ababa, Ethiopia

Abstract

Abstract Background: Each year around 20-50 million people are injured in road traffic accidents. Developing countries account for ninety percent of these injuries. Femoral shaft fracture is among the most common fractures encountered in orthopaedic surgery practice and can be cause of prolonged morbidity and extensive disability unless treatment is appropriate. Treatment of femur fracture evolve through time from conservative methods like traction to operative management with locking intramedullary nails. Currently, closed locking femoral nail is the standard of treatment for femoral shaft fracture, but it is technically demanding and requires fluoroscopy and fracture table. Since January 2008, SIGN nail which is a solid interlocking intramedullary device designed, manufactured and distributed by SIGN, become available. The surgical approach for insertion of nail can be antegrade or retrograde. Studies With specially designed retrograde nails showed acceptable knee functional outcomes, but long term studies have showed lower limb pain, knee stiffness were seen with this method. This will significantly implicate on socio-economic performance and overall satisfaction of patients. Objective: To identify factors associated with knee range of motion after retrograde femur shaft nailing. Methods: A facility based retrospective cross-sectional study will be conducted among all patients with femur shaft fracture who were treated with retrograde SIGN nail at AaBET hospital during the study period and fulfil inclusion criteria and lack exclusion criteria. A self prepared data collection sheet was developed by review of literature used to document the data in English and data was collected from patient medical record charts, operation note, patient imaging record, and SIGN surgical database system. . Data entry was performed by using Epi info version 3.5.4 and SPSS version 20 for analysis. Simple tabulation and descriptive statistics used to describe general characteristics of patients and their fractures. Binary and Multivariate logistic regression was be used to assess the significant association between the independent factors and the outcome variable. Result: So 71 patient medical chart records were available for analysis. Among the 71 patients, 51 (71.8%) patients are male the rest 20 (28.2%) are female patients. The average age of patients was 34.35 (SD=13.92) years and patients between age range of 17to 76 underwent the procedure. Road traffic accident is the most common cause of femur shaft fracture accounting for 47.9% of cases. In 50.7% of cases the middle third segment of the femur is involved. The mean time from injury to intramedullary nail insertion is 12.97days (SD=13.481) with days ranging from 0 to 94 days. Radiographic fracture union was seen in 98.6% (n=70 patients) of cases. Good range of motion was seen in 78.9% (n=56 patients) and poor range of motion was seen in 21.1% (n=15 patients). Using multivariate logistic regression, age ((AOR 1.074, 95% CI (1.013, 1.139)) and time from injury to intra-medullary nail insertion (AOR 1.112, 95% CI (1.022, 1.209)) were shown to be statistically associated with knee range of motion. Conclusion: Retrograde nailing is an option in the management of diaphysial femur shaft fracture. Its use should be tailored in old age group and in patient with prolonged duration VIII from injury to intra-medullary nail insertion because of significant association with poor knee range of motion.