Patterns of Non-union of Femoral Shaft Fracture in Basra Teaching Hospital. A Retrospective review.

Abstract

Long bone fractures are witnessed almost every day in the orthopedic practice. Femoral shaft fractures (FSF) generally are due to high energy trauma in working age group patients. Variety of fracture patterns are encountered with different treatment choices are available, however, non-union of FSF is not infrequently encountered challenge. This study reviews cases of FSF that ends up with non-union in Basrah Teaching Hospital in an attempt to explore some factors associated or probably led to non-union. This is a retrospective case series study were conducted in Basrah Teaching Hospital from January 2012 to June 2014 including 124 patient with FSF. Thirty three patients were identified during the study period (18 months), demographic criteria and injury patterns, initial treatment, early complications, subsequent interventions and fate of the patients are described. Among 33 patients with nonunion FSF, 23 were males and 10 females, aged from 15 to 60 years (mean = 35), 10 (31%) were active smokers during the period of treatment. High energy trauma is the chief source of FSF in this analysis ,27(82%), middle third fracture is the commonest site 20(60%), although 17(52%) was initially closed fracture , 16(48%) open fracture and 14/33 (42%) comminuted fracture. All patients with closed fractures as well as 4 patients with compound fractures had been treated by open reduction with internal fixation, and other patients treated by external fixation. The most commonly documented complication was the development of surgical site infection in 13 (39%) patients. After the elapse of 9 12 months from the time of initial trauma, the patients ends up with a diagnosis of non-union, 9(27%) patients developed atrophic nonunion, 13(39%) patients developed hypertrophic non-union and 11 (33%) patient developed infected non-union. Thirty patients underwent revision surgery, with addition of bone graft in most of the instances, and three patients no revision surgery, several types of bone grafts had been utilized during the revision surgery in 28 patients (out of 30) , within the study period ( 18 months ), 25(75%) patients achieved successful union or showing signs of progressive union , 3 (10%) patients had united fractures with chronic osteomyelitis , while 5(15%) patients still with non-united fractures . In conclusion; the nonunion of FSF is still a great challenge to the orthopaedic surgeon and unlimited obstacle to the patient life and development, therefore from 124 who sustained fracture femur thirty three developed nonunion and after numerous sessions of medical and surgical interventions only five patients still non united fracture, thus to overcome this problem both the surgeon and the patient should cooperate to avoid this tragedy story.