Evaluation of the Results of Diaphyseal Fracture of Femur (Winquist Type II, III and IV) Treated by Open Antegrade Sign Nailing

Introduction: Fracture femur shaft most commonly occurs as a result of high velocity trauma. In the past, these fractures have been treated by various techniques like traction and conservative methods, operative methods like plating, intramedulary nailing. With the advent of Interlocking sign nailing involving diaphyseal fracture of femur in adult have resulted in far better outcomes. The poor patients in our country, who have no assets, suffer the most. The Surgical Implant Generation Network (SIGN) was established in January, 1999 as a humanitarian, nonprofitable organization in the state of Washinton, USA, to provide free of cost and one of the best treatments for long bone fracture in developing country. To find out the result in the treatment of closed diaphyseal fracture of femur (Winquist Type II, III, IV) in adult by open antegrade interlocking SIGN nailing at NITOR. This was a close observational study conducted at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh. Forty-five patients with closed diaphyseal fracture (winquist type II, III & IV) of femur who attended emergency and outpatient department and admitted to NITOR from Jan 2018 to Dec 2019. Mean age of the patients was 36.20 years and majority of patients (93.30%) were male, with male female ratio of 13:1. In most of the cases, injury was high- energy trauma (91.1%) due to road traffic accident, and there was preponderance of fracture on the right side (35.0%). All the patients reported early after trauma and majority of the patients (66.6%) were operated within 4 weeks. Patients were followed-up postoperatively up to 12 months. All the fractures were fixed by interlocking intramedullary SIGN nail in open procedure. But 4 patients required dynamization and result was delayed union. 1 patient had wound infection before definitive surgery and controlled with Amikacine. At the end of follow-up functional scoring was done on the basis of score cited by Thoresen and the results were excellent in 60% cases, good 28.90%, fair 11.10% [1]. All achieved union and no evidence of implant failure was seen. 88.9% (60%+28.90%) patients result wear satisfactory. Intramedullary nailing (SIGN) has given satisfactory results in my study.