Conservative management of closed femoral shaft fractures - is skeletal traction still justified or cost effective in a developing country like Tanzania?

Abstract

Closed femoral shaft fractures have always been a challenge to orthopaedic surgeons and traumatologists for many years. They account for high morbidity rates in trauma wards, prolonged hospitalization as well as affecting the productive age group of the society. In the developed world surgery is now the first option of treatment rather than conservative treatment. In the developing world however, owing to lack of both qualified personnel and funds to purchase modern implants, conservative treatment still remains the mainstay of treatment. The broad objective of this study was to determine medical and financial benefits of embarking on early surgery of femoral shaft fractures versus conservative treatment in the form of continuous skeletal traction. Specifically to determine lengths of hospitalization, early and late medical complications encountered as well as the cost incurred by both the patient and the hospital on both types of treatment. The study included patients admitted at Muhimbili Orthopaedic Institute with closed femoral shaft fractures during the period of August 2003 to July 2004 and of ages 11 to 72 years. There were 91 patients with closed femoral shaft fractures enrolled into the study, out of these 8 were lost to follow up and the remaining 83 were treated. 42 patients were managed by continuous skeletal traction and 41 by open reduction and internal fixation.