“Functional Outcome in Exchange Nailing with Autogenous Cancellous Bone Graft for Aseptic Nonunion of Femoral Shaft: A Study in Pabna Medical College Hospital, Pabna, Bangladesh”

Abstract

Original Research Article Femoral shaft non-union is a functional and economical challenge for the patient as well as a treatment dilemma for the surgeon. The Association for Osteo-synthesis (AO)' as a means of preventing the development of fracture disease and early recovery. Intramedullary (IM) nailing is the gold standard for the management of femoral shaft fractures. To find out the Functional outcome in exchange nailing with autogenous cancellous bone graft for aseptic nonunion of femoral shaft. From July 2015 to June 2017, more than 30 patients of femoral shaft aseptic nonunion were treated with this technique at Pabna Medical College Hospital and clinics in Pabna, Bangladesh. 21 patients were finally recorded for study. Among them 1(one) patient was lost after 04 weeks before fracture healing. Culture of the 1st reaming materials revealed growth in 2 cases. So, final outcome, analysis and test of significance were done with 18 patients. Mean age 41.95 Years; SD ± 13.11; Male: Female = 3.3:1 Among 18 fractures nonunion, 15 fractures (83.33%) were united and 3 fractures (16.67%) were not united after exchange nailing with autogenous bone graft in aseptic condition. Confidence Interval at 95% level 66.08%-100%. Mean union time was 26.00 ±4.5 weeks where 95% confidence interval was 23.49±28.51weeks including both static and dynamic mode of fixation. In static mode mean union time were 29.33±3.01 weeks whereas in early dynamic it was 21.33±1.63 weeks. It was also calculated that after late dynamization mean union time was 28.67±2.309 weeks. Among complications unacceptable Angle deviation 5.6%, Limb length discrepancy 5.6%, Pain-Swelling 5.6%, Infection 11.12%, Joint motion restriction 5.6%, Implant failure 5.6%. There was a strongly positive correlation between age and union time; that means more the age more the union time. In this study, it was found that smoking and NSAIDs both had significant relation (p<0.05) with fracture union time. Highly strong (+) ve correlation was found between non union period and union time after exchange nailing. Final outcome according to modified Thoresen's score was Satisfactory78%; according to modified Silvia's score was 10.83 ± 2.203. In fracture united cases postoperative SF-MFAS Function Index was achieved 2.5 ±1.7and Bother index was achieved 1.89±1.08.There was a highly significant (p<0.001) difference between pre operative and post operative functional outcome after exchange nailing with open bone graft as a whole. Exchange nailing with autogenous cancellous bone graft seems to be an effective method of treatment in femoral shaft nonunion after intramedullary nailing. It provides a good scope to reinforce the optimum mechanical stability by a larger diameter nail and locked if necessary; as well as biological stimulation by reaming and open bone grafting.