The approach to Intramedullary (IM) fixation of long bone fractures remains a controversial issue. Early reports demonstrated less favourable results of retrograde nailing as compared with antegrade options due to higher non-union rates. The aim of this audit was to evaluate the outcomes of practice within the Trauma and Orthopaedic department with relation to IM nail fixation of diaphyseal femur fractures. The Trauma database between February 2010 and September 2013 was used to identify all femur IM nailing procedures. Picture Archiving and Communication System (PACS) software was used to classify the fractures according to the Muller AO classification. All 3–2 (Diaphyseal femur fractures) were included in the audit. PACS imaging together with outpatient documentation was evaluated for radiological and clinical outcome.Background
Methodology
We carried out a protocol driven study of 30 consecutive patients who had an infected hip arthroplasty and were treated with two stage uncemented revision hip surgery. There were 23 males (average age 65 years) and 50% of the patients were obese. Radical debridement of hip was performed to achieve control of infection at first stage surgery. Twenty patients grew one organism and 10 patients had multiple organisms grown. The predominant organism was Staphylococcus epidermidis. Eight patients had MRSA/MRSE. All patients were treated with antibiotics for at least three months. The mean time to reimplantation was 4.7 months. In 15 patients, allograft was used for reconstruction in the second stage. All patients were followed up clinically and radiologically and mean follow up was 4.2 years. No patient was lost to follow up. Rate of eradication of deep infection was 100%. Two patients required re-debridement for stitch abscesses which healed without sequeale. Only two patients (6%) had poor result as assessed by Harris Hip score, Merled Aubigne score and SF12 score. Sixty-seven percent of patients had good to excellent result and 27% had fair outcome. The poor results correlated to the old age and other significant co-morbidities in these patients. One patient died due to unrelated cause after eight years of surgery. Radiographically, all but one implant were well fixed at review. One patient had a radiolucent line around the acetabulum and was radiologically and clinically loose. There is no clinical or haematological evidence of infection. Twelve patients had heterotopic ossification and four patients had trochanteric non-union but no pain. One patient developed sciatic nerve palsy and one patient had recurrent dislocation. This medium term review has revealed that a satisfactory outcome of a difficult problem can be achieved by using a standardised treatment protocol and uncemented implants.
