The size, structure, and role of the femur make it a major load bearing bone in the body. Fractures of the femur present with varied patterns in aetiology, treatment modality and outcome. Fracture of the femur usually follows significant trauma which often can be life-threatening particularly in young persons. Even in the elderly, the consequence of fractured femur can be life-threatening.
This study aims to evaluate the pattern of presentation of fractures of the femur treated in a regional trauma centre in South South, Nigeria.
Prospectively collected data of patients presenting with fractured femur at the regional trauma centre from 1st January 2006 to 31st December 2011 was retrospectively evaluated, looking at patterns of presentation, treatment given and outcome. Descriptive statistics were generated and presented from the observed results and inferences drawn where necessary.
One thousand three hundred and thirty-four cases of fractured femur were treated at the centre during the period constituting about 10.9% of the fractures treated. All age groups were affected with significant majority of cases seen in the age group (21 to 30) years (n = 411, 30.8%) following road traffic crashes (970, 72.7%) p < 0.0001. Ground level fall was the commonest cause (38, 2.8%) in elderly persons particularly females (23, 1.7%). Most of the fractures were closed ({1040, 78%} P < 0.00001), involving the shaft of the femur (775, 56.1%). The proximal and distal femur were equally not spared (n = 330; 16.5%, n = 339; 25.4%) respectively.
Majority of the patients particularly adults were treated by operative methods including open reduction and internal fixation with intramedullary nails (629, 47.2%), plates and screws (206, 15.4%), and K-wires (18, 1.3%), external fixation (176, 13.2%) and amputations (n = 5, 0.4%). Non-operative treatments included casting with Plaster of Paris (136, 10.2%) and Traction (135, 10.1%). Majority of the fractures (1113, 83.7%) had attained significant union at six months post-injury to allow for a return of significant function (COST Score 70% and above) in 1035 (77.1%) of cases. Seventy-two (5.4%) cases of post-treatment infection were recorded with the infection rates highest in the open fractures grade IIIA (n =30/10, 27.5%) to grade IIIC (n = 4/8, 50%).
Fractures of the femur have varied presentation. High energy injuries mainly from road traffic crashes was a significant contributor. Whatever treatment option adopted, application of sound principles and established guidelines produces acceptable results even the face of limited resources.