Comparison of short-term outcome between day and night timing of intramedullary nailing of the diaphyseal femur fractures in adults at Muhimbili Orthopedic Institute

Abstract

Background Timing of intramedullary nailing in femoral diaphyseal fracture has been an area of controversy for quite some time. It is being guided by two principles of management whether early total care or Damage control orthopedics. In carefully selected patients early total care is advocated whereby it is recommended to operate these patients within 24 hours of injury and in other settings up to 48hours. This has led to operating these patients even at night time. Objective This study aimed at comparing the surgical outcomes of intramedullary nailing carried out during the daytime and those carried out during the night. Methodology This was a comparative cohort study with two arms of the operations done during the day and operations were done during the night on adult patients with femoral diaphyseal fractures. A total of 66 patients were enrolled using the consecutive sampling method. Data was collected using an objectively structured questionnaire. Duration of surgery, nail entry point, limb length discrepancy, and degrees of rotation was assessed on those patients depending on the time of operation. Data was coded cleaned and analyzed using SPSS version 20, descriptive statistics and inferential statistics were used in this study. A p-value of < 0.05 was considered statistically significant. Results 30 patients were operated on during the night. Patients with proximal shaft fractures were more likely to be operated on during the day whereas those with comminuted midshaft fractures were operated on during the night. The median operation time was 124 minutes during the night and 122 minutes during the day. In 2 patients unexpected nail entry points were used based on the fracture pattern at night compared to 1 patient in whom an unexpected nail entry point was used during the day. Limb length discrepancy of 1-2 cm was found in 4 patients who were operated on during the night and 2 patients who were operated on during the day (p=0.399). 2 patients who were operated on during the night had 11-15 degrees of rotation and 2 patients who were operated on during the day had also 11-15 degrees of rotation (p =0.621). It was found that there was no statistical significance in surgical outcome in terms of limb length discrepancy, degree of rotation when the surgeries were done during the day and night. Conclusion Following this study, it was found that the time at which the diaphyseal femur fracture is treated has no significant difference in the surgical outcome and therefore doing this operation at any time maximizes the use of theatre