Intramedullary interlocking nailing for diaphyseal fractures is a standard treatment option in affluent societies. These procedures are often performed under image intensifier guidance. The cost of these gadgets precludes their common use in resource poor regions. External jig-aided intramedullary interlocking nailing is relatively cheap and offers the chance for performing these procedures in resource poor regions. The aim of this study was to document the advantages, challenges and outcome of this form of treatment in a resource poor setting. The Surgical Implant Generation Network (SIGN) implants and instrumentation were used for this study. Thirty-seven limbs in 35 patients were included. There were 30 males and five females giving a ratio of 6:1. The mean age was 35 ± 11.9 years with a range of 15-61 years. The femur and tibia were the bones studied with a total of 23 and 14 fractures, respectively (ratio 1.6:1). There were 14 comminuted fractures, two segmented fractures, six mal-unions, eight non-unions and seven simple fractures. Road traffic accidents were the most common cause of injuries with motorcycle accidents accounting for 19 (57.4%) cases. The mean follow-up period was 22 ± 5.32 months, mean time to union was 16.9 ± 5.4 weeks and the major complication was osteomyelitis (10.8%). We conclude that this is a viable treatment option for musculoskeletal injuries in resource poor regions. Education to encourage early acceptance of surgical intervention and reduced patronage of traditional bone setting for injudicious interventions can reduce the infective complication rates.

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Majority of open fractures in Nigeria result from road Traffic Accident (RTA). This is partly due to bad roads and reckless use of motor cycles as the main means of intra-city transport. (Udosen, et al, 2004; Udosen, AM, Ugare G, 2005) These are precarious injuries associated with severe complications leading to amputation. This procedure devised by the authors was designed to reduce these complications, particularly because amputation is not yet acceptable in our environment, where ignorance, poverty and stigmatization are common. This procedure is simple and cheap and has a satisfactory result in an environment of limited resources. The study was done at the University of Calabar teaching hospital within a period of 6years. 62 limbs in 60 patients were salvaged using this procedure at an average of about 10 salvaged limbs per year. 66% (41) of them had regained full function while 28% (17) were still undergoing various forms of rehabilitations. 6% (4) had amputation because of flail limbs and or severe infections. Male: female ratio was 4:1 and the average age was 32years (17-52yrs). All the injuries were caused by road traffic accident and 60% of this were due to motor cycle accidents. The average mangled extremity severity score (MESS) for the injured limbs was 4.5 (3-7). Complications encountered in the study included pin tract infection 58%,wound infection 26%,Chronic osteomyelitis 12%,gross deformity and flail limb 6%,graft failure 6%, Chronic pain 4% Improvement on this method requires adequate funding and provision of necessary equipment as well as training of personnel.