Retrograde intramedullary nailing of femoral fractures with SIGN FIN Nail: an experience at Ghurki Trust Teaching Hospital

Background: Retrograde intramedullary nailing of femur is now an established method of fixation of mid-shaft and distal femoral fractures. Other indications include ipsilateral femoral neck and shaft fractures, floating knee injuries, obesity and pregnancy. Objective: To determine the outcome of retrograde femoral nailing with SIGN FIN Nail in patients with minimally comminuted mid and distal diaphyseal femoral fractures in terms of radiological union, SMFA score and complications. Material and Methods: A descriptive case study incorporating 71 patients was conducted from April 2016 to June 2017 at Orthopedic Unit of Ghurki Trust Teaching Hospital, Lahore. Patients were admitted through emergency department. After following ATLS protocol, diagnosis was confirmed with orthogonal radiographs. After proper informed consent, Retrograde intramedullary nailing of the femoral fractures was done using SIGN FIN nail. Outcome was assessed in terms of radiological bony union, SMFA score and post-operative complications. Follow-up was done at 2 weeks, 4 weeks, 3 months and 6 months Results: Mean age was 35.1+- 11.8 with 53(74.6 percent) males and 18(25.4 percent) females. 42(59.1 percent) fractures were mid-shaft and 29(40.9 percent) were distal diaphyseal. Mean follow-up time was 4.7 months (2-7 months). Radiological union was achieved in 92 percent of the patients at a mean follow-up of 4.5 months. Mean improvement in SMFA score was 56. 2(2.8 percent) patients lost to follow-up. 3(4.2 percent) patients developed superficial SSI which settled with antibiotics. 2(2.8 percent) patients later required exchange nailing and bone grafting for non-union. Conclusion: Retrograde intramedullary nailing with SIGN FIN nail is easy to perform, time saving and results in excellent union rates. Good post-operative and long term musculo-skeletal function can be expected. (author)