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Perdomo-Lizarraga JC, Andrade-Arellano DJ, Necchi M, Zavatta M, Ryan-Coker M, Dixon-Cole R, Muñoz-Mahamud E, Combalia A. Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries? INTERNATIONAL ORTHOPAEDICS 2024; 48:2179-2187. [PMID: 38761212 PMCID: PMC11246262 DOI: 10.1007/s00264-024-06192-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/15/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach. MATERIAL AND METHODS This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated. RESULTS A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57). CONCLUSIONS Both options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.
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Affiliation(s)
- Juan Carlos Perdomo-Lizarraga
- Emergency Surgery Centre, Goderich-Freetown, Sierra Leone.
- Department of Orthopedics, University Hospital of Jaen, 23009, Jaen City, Spain.
| | - Dennys J Andrade-Arellano
- Emergency Surgery Centre, Goderich-Freetown, Sierra Leone
- Orthopaedic Department, IRCCS Galeazzi Hospital- Sant'Ambrogio, 20157, Milan, Italy
| | - Marco Necchi
- Emergency Surgery Centre, Goderich-Freetown, Sierra Leone
- Hand Surgery Department, MultiMedica Hospital, 21053, Castellanza, Italy
| | | | - Marcella Ryan-Coker
- Emergency Surgery Centre, Goderich-Freetown, Sierra Leone
- Department of Surgery, University of Nairobi, Nairobi, Kenya
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Ernesto Muñoz-Mahamud
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de La SalutUniversitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036, Barcelona, Spain
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain
| | - Andrés Combalia
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de La SalutUniversitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C. Villarroel, 170, 08036, Barcelona, Spain.
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036, Barcelona, Spain.
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Perdomo-Lizarraga JC, Andrade-Orellano DJ, Necchi M, Zavatta M, Ryan-Coker M, Dixon-Cole R. Usefulness of external fixation and reverse Sural fasciocutaneous flap: Treatment of grade III B open tibial fractures in resource-limited settings. Injury 2024; 55:111349. [PMID: 38277877 DOI: 10.1016/j.injury.2024.111349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/28/2024]
Abstract
PURPOSE Sierra Leone is a low-income country located on the west coast of Africa where the majority of the population does not have free access to emergency medical and surgical services, the principal cause of open tibia fractures is motorcycle collision. Open fractures of the middle and distal third of the tibial segments, particularly those classified as type III B, represent a challenge for orthopedic surgeons because of the loss of soft tissue coverage. The Reverse Sural Fasciocutaneous Flap (RSFF) has been shown to be an ideal and reproducible option for the treatment of soft tissue defects. The main aim of this study was to demonstrate the experience in Resource Limited Settings (RLS) by means of a short series of the efficacy of using a combination of external fixation and RSFF in the treatment of grade III B open tibia fractures where plastic surgeons were not available. METHODS This retrospective, descriptive, and non-experimental study included 8 patients who underwent surgical intervention between September 2020 and September 2021. RESULTS The skin defects were of various sizes; the smallest size was 4 × 7 cm, and the biggest size of 12 × 18 cm. We obtained a success rate in seven of the eight cases. CONCLUSIONS External fixation and reverse sural fasciocutaneous sural flap are excellent therapeutic options for the treatment of open grade III B diaphyseal and metaphyseal distal tibial fractures.
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Affiliation(s)
- Juan Carlos Perdomo-Lizarraga
- Emergency Surgery Centre, Goderich, Sierra Leone,Africa; Department of Orthopedics, University Hospital of Jaen, 23009, Jaen city, Spain.
| | - Dennys J Andrade-Orellano
- Emergency Surgery Centre, Goderich, Sierra Leone,Africa; Department of Orthopedics, Galeazzi Orthopedic Institute, 20161, Milan, Italy.
| | - Marco Necchi
- Emergency Surgery Centre, Goderich, Sierra Leone,Africa; Department of Surgery and Orthopedics, Sterzing Hospital, Margarethenstraße 24, 39049 Sterzing, Italy.
| | | | - Marcella Ryan-Coker
- Emergency Surgery Centre, Goderich, Sierra Leone,Africa; Department of Surgery, University of Nairobi, Nairobi, Kenya; College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK.
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