Factors Affecting Long Term Outcome of Rigid Intramedullary Nailing of Lower Limb Diaphyseal Fractures in Older Children

Introduction: Our study aims to assess long term treatment outcomes in children over 10 years of age treated with rigid Surgical Implant Generation Nail (SIGN) and the factors influencing outcomes specifically limb shortening and squat and smile grade. Materials and Methods: This is a retrospective study. Data from 21 patients aged between 12 to 18 years with fractures of the shaft of the femur or tibia treated with SIGN intramedullary nails over a 48-month period was analysed. Data were collected from the SIGN online database, patient case notes and radiographs. Patients were followed up for a period of 2 to 4 years. Patient’s variables such as age, sex, weight, mechanism of injury, history of previous surgery, associated injuries, time to surgery, co-morbidities were analysed. Fracture type, AO classification, time to union, implant size and complications were analysed. Limb length discrepancy and squat and smile sign scoring were the outcome measures. Statistical analysis was performed using the SPSS. Statistical significance was set at p Results: The age range was 12 to 18 years with the mean age at 15.95 years (SD = 1.86). The mean time to fracture healing was 25.71 weeks ± 7.88. Limb shortening in operated limbs of those with no previous surgery was (0.44 ± 0.86 cm) while those who had plate and screw fixation before surgery was 2 cm (p = 0.027). It could be observed that of all the variables studied only the patients who had a previous surgery (plate and screw fixation) were noticed to have poor squat and smile outcome compared to those who had no previous surgery. Conclusion: Previous surgery on the limb with plate and screws resulted in more cases of limb length discrepancy and poorer lower limb function as assessed with the squat and smile score.