External jig-aided intramedullary interlocking nailing of diaphyseal fractures: experience from a tropical developing centre

Intramedullary interlocking nailing for diaphyseal fractures is a standard treatment option in affluent societies. These procedures are often performed under image intensifier guidance. The cost of these gadgets precludes their common use in resource poor regions. External jig-aided intramedullary interlocking nailing is relatively cheap and offers the chance for performing these procedures in resource poor regions. The aim of this study was to document the advantages, challenges and outcome of this form of treatment in a resource poor setting. The Surgical Implant Generation Network (SIGN) implants and instrumentation were used for this study. Thirty-seven limbs in 35 patients were included. There were 30 males and five females giving a ratio of 6:1. The mean age was 35 ± 11.9 years with a range of 15–61 years. The femur and tibia were the bones studied with a total of 23 and 14 fractures, respectively (ratio 1.6:1). There were 14 comminuted fractures, two segmented fractures, six mal-unions, eight non-unions and seven simple fractures. Road traffic accidents were the most common cause of injuries with motorcycle accidents accounting for 19 (57.4%) cases. The mean follow-up period was 22 ± 5.32 months, mean time to union was 16.9 ± 5.4 weeks and the major complication was osteomyelitis (10.8%). We conclude that this is a viable treatment option for musculoskeletal injuries in resource poor regions. Education to encourage early acceptance of surgical intervention and reduced patronage of traditional bone setting for injudicious interventions can reduce the infective complication rates.