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Predictors of Reoperation for Adult Femoral Shaft Fractures Managed Operatively in a Sub-Saharan Country.

Abstract The optimal treatment for femoral shaft fractures in low-resource settings has yet to be established, in part, because of a lack of data supporting operative treatment modalities. We aimed to determine the reoperation rate among femoral fractures managed operatively and to identify risk factors for reoperation at a hospital in a Sub-Saharan country.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title the journal of bone and joint surgery. american volume
Publication Year Start




PMID- 28244909
OWN - NLM
STAT- MEDLINE
DA  - 20170228
DCOM- 20170308
LR  - 20170308
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Linking)
VI  - 99
IP  - 5
DP  - 2017 Mar 01
TI  - Predictors of Reoperation for Adult Femoral Shaft Fractures Managed Operatively
      in a Sub-Saharan Country.
PG  - 388-395
LID - 10.2106/JBJS.16.00087 [doi]
AB  - BACKGROUND: The optimal treatment for femoral shaft fractures in low-resource
      settings has yet to be established, in part, because of a lack of data supporting
      operative treatment modalities. We aimed to determine the reoperation rate among 
      femoral fractures managed operatively and to identify risk factors for
      reoperation at a hospital in a Sub-Saharan country. METHODS: We conducted a
      prospective clinical study at a single tertiary care center in Tanzania,
      enrolling all skeletally mature patients with diaphyseal femoral fractures
      managed operatively from July 2012 to July 2013. Patients were followed at
      regular intervals for 1 year postoperatively. The primary outcome was a
      complication requiring reoperation for any reason. Secondary outcomes were scores
      on the EuroQol (EQ)-5D, radiographic union score for tibial fractures (RUST), and
      squat-and-smile test. RESULTS: There were a total of 331 femoral fractures (329
      patients) enrolled in the study, with a follow-up rate at 1 year of 82.2% (272 of
      331). Among the patients with complete follow-up, 4 injuries were managed with
      plate fixation and 268 were managed with use of an intramedullary nail. The
      reoperation rate for plate fixation was 25% (1 of 4) compared with 5.2% (14 of
      268) for intramedullary nailing (p = 0.204). As found in a multivariate logistic 
      regression, a small nail diameter, a Winquist type-3 fracture pattern, and varus 
      malalignment of proximal fractures were associated with reoperation. The mean
      EQ-5D score at 1 year was 0.95 for patients who did not require reoperation
      compared with 0.83 for patients who required reoperation (p = 0.0002).
      CONCLUSIONS: Intramedullary nailing for femoral shaft fractures was associated
      with low risk of reoperation and a nearly full return to baseline health-related 
      quality of life at 1 year of follow-up. There are potentially modifiable risk
      factors for reoperation that can be identified and addressed through education
      and dissemination of these findings. LEVEL OF EVIDENCE: Prognostic Level I. See
      Instructions for Authors for a complete description of levels of evidence.
FAU - Eliezer, Edmund N
AU  - Eliezer EN
AD  - 1Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania 2Institute for Global
      Orthopaedics and Traumatology, Orthopaedic Trauma Institute, San Francisco
      General Hospital, San Francisco, California 3Department of Orthopaedic Surgery,
      University of California, San Francisco, San Francisco, California.
FAU - Haonga, Billy T
AU  - Haonga BT
FAU - Morshed, Saam
AU  - Morshed S
FAU - Shearer, David W
AU  - Shearer DW
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - AIM
SB  - IM
MH  - Adult
MH  - Bone Plates
MH  - Developing Countries
MH  - Female
MH  - Femoral Fractures/*epidemiology/*surgery
MH  - Follow-Up Studies
MH  - Fracture Fixation, Internal
MH  - Fracture Fixation, Intramedullary
MH  - Humans
MH  - Male
MH  - Poverty
MH  - Prognosis
MH  - Prospective Studies
MH  - Quality of Life
MH  - Recovery of Function
MH  - Reoperation
MH  - Risk Factors
MH  - Tanzania/epidemiology
MH  - Young Adult
EDAT- 2017/03/01 06:00
MHDA- 2017/03/09 06:00
CRDT- 2017/03/01 06:00
AID - 10.2106/JBJS.16.00087 [doi]
AID - 00004623-201703010-00004 [pii]
PST - ppublish
SO  - J Bone Joint Surg Am. 2017 Mar 1;99(5):388-395. doi: 10.2106/JBJS.16.00087.

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