Purpose: Femoral shaft fracture (FSF) is the second most common fracture in Cameroon. As most of the low- to middle-income countries (LMICs), image intensifier and traction table are not always available for locked intramedullary nailing (IMN). In the absence of these devices, distal locking is one of the most difficult challenges. The aim of this study was to compare the results of 3 techniques for distal locking of IMN of the femur without image intensifier or traction table in Yaoundé.
Methods: All adult patients who underwent femoral IMN with distal locking without image intensifier or traction table in a tertiary care hospital in Yaoundé from June 2015 to December 2020, with a follow-up period ≥12 months, were included in this retrospective study. Their medical reports were reviewed, and then patients were invited for a final radioclinical evaluation. The primary outcome was the success of the distal locking evaluated by 2 independent orthopaedic surgeons on postoperative AP and lateral radiographs. The secondary outcomes were bone healing at final evaluation and functional outcome using Lower Extremity Functional Scale (LEFS).
Results: Out of the 128 cases, 3 techniques for distal locking of the femoral nail were used: the “nail guide” technique (59.3% of the cases), the “cortical flap” technique (17.1% of the cases), and the technique using a special IMN instrument set designed for distal locking without image intensifier (23.6% of the cases). The success rates for distal locking were 100% for the cortical flap technique, 94.9% for the nail guide technique, and 50% for the special instrument set technique (P = 0.001). However, we recorded 1 case of fracture at the cortical flap site. With a mean follow-up period of 40.8 ±18.4 months, bone healing without major complications was achieved in 83.6% of patients, with no significant difference between groups. The functional outcome were good to excellent in 82% of cases.
Conclusion: The nail guide and cortical flap techniques appear to be reliable for successful distal locking of femoral nails in the absence of image intensifier in low resources settings.
