Intramedullary Interlocking Nailing for Long Bone Fractures of the Lower Limbs: Our Experience with Free-hand Locking

Aims: To see the pattern of interlocking nailing used for fractures of lower limb’s long bones in terms of the bone affected, laterality, age distribution, sex distribution, pattern of locking and early outcome.

Study Design: The study is a retrospective cross sectional study conducted over three years from April 2013 to march 2016 in a private hospital in Kano, North western Nigeria.

Methodology: All patients that had intramedullary nailing for femoral and/or tibial fractures within the period of study, were recruited. Theatre register was used to extract the file numbers of the patients. The folders were retrieved and the information extracted. The Data was analysed using XLStat software.

Results: The age ranges from 19 -70 years with a majority between 20-39 years. There is only one person below the age of twenty and is in the male category. There were a total of 87 procedures conducted on 81 patients of which 70(86.4%) were males and 11(13.6%) were females. Only 77% of the interlocking nail were locked at both ends, the remaining were locked at one end with the other end abandoned due to difficulty in getting the hole or actually not attempted. Of the 87 nailings, 5 were inappropriately locked outside by the side of the distal nail and 2 were locked distal to the tip of the nail. One femoral and 3 tibial, developed non-union requiring exchange nailing with a larger diameter nail and cancellous bone graft. 6 patients developed surgical site infection which were manage successfully with antibiotics and wound care with only 2 tibial nails requiring conversion to external fixation using Linear Rail system for compression. 70(86%) of the patient were satisfied with their treatment with very good – excellent range of motion, while 11(14%) patient have either of reduce range of motion, anterior knee pain or abnormal gait.

Conclusion: Most challenging aspect of the procedure were intraoperative radiography was not available, is correct placement of the distal locking screws. Use of a distal targeting device is the main stay, while using the guide wire to sound the drill bit/screw increases the chances of accurate placement.