Short-term outcome of proximal femur fractures treated with Cephalomedullary nailing at Mulago National Referral Hospital in Uganda

Abstract

Cephalomedullary nailing (CMN) is a well-documented treatment option for proximal femur fractures (PFFs), allowing early patient mobilization thus reducing morbidity and mortality. Despite its popularity, surgical challenges persist, leading to unfavorable outcomes such as secondary varus collapse, non-union, hip pain, leg length discrepancy, Z and reverse Z-effect. This study aimed to describe functional and radiological outcomes among patients with PFFs treated by CMN. We recruited 53 participants consecutively done CMN from August 2021 to January 2023. Functional outcomes were assessed using the adapted Harris Hip score (HHS), while radiological outcomes were evaluated using pre-operative, postoperative, and follow-up study plain radiographs. Data were collected using a structured questionnaire, entered into Epi Info, and analyzed using STATA version 15.Results: The participants' mean (SD) age was 44.4±15.6 years and ranged from 19 to 81 years. Males were predominantly affected with a ratio of 2:1. Road traffic accidents (RTA) were thecommon mechanism of injury accounting for 42 (79.3%) cases, followed by domestic falls at 8 (15.1%). Trochanteric fractures were the most common subtype and occurred in 24 (45.2%) patients, while sub-trochanteric fractures significantly reduced the risk of secondary varus collapse (P-value=0.045). Patients who had surgery 14 days post-injury were 35 (66%), and the proximal femoral nail (PFN) was the common implant used in 45 (84.9%) cases. Good to excellent short-term functional outcomes were achieved in 37(69.8%), and 48 (90.6%) patients had radiological union. However, only 38 (71.1%) patients had restored neck-shaft angle. Z and reverse Z-effects occurred in 2 (3.8%) patients. Acceptable reduction was achieved in 36 (73.5%) patients. Poor reduction quality increased the risk of secondary varus collapse (p-value =0.008), while open reduction reduced the risk of poor functional outcomes by 80% (Odds ratio=0.2). Conclusion: 69.8% of the patients had good to excellent (favorable) functional outcomes following treatment with CMN. Fracture union rates were comparable to those in other treatment centers in the Developed world. Secondary varus collapse was the most common complication in 28.3% of the patients.