• BACKGROUND
    • Open Grade 3 femoral fractures are high-velocity injuries, often associated with other co-morbid injuries and are highly prone to infections; these fractures are commonly treated by staged procedures to minimize the complications. Early definitive fixation by intramedullary (IM) interlocking nails (ILN) has advantages like early mobility and better outcomes.
  • STUDY QUESTION
    • Are early definitive fixations of grade III shaft femur fractures with debridement & IM ILN effective in union and infection rates?
  • MATERIALS AND METHODS
    • Using relevant keywords, a total of 3357 articles were screened from the PubMed, Scopus and Embase database. 6 studies that evaluated at least 10 cases of grade III open femoral shaft fractures treated with early IM ILN during the index surgery were included in this review.
  • RESULTS
    • Out of the 6 studies, only 1 was prospective, and the remaining 5 were retrospective in design. Out of 176 Grade III fractures, there were 8 non-unions, 3 malunions and 1 case of delayed union. Pooled analysis showed union rates of 94.8% for these fractures (4 studies). Infection was the most common complication. Pooled analysis showed that the mean rate of infection in these grade III fractures was 6.7%. Other complications included limb length discrepancy and stiff knee.
  • CONCLUSION
    • Intramedullary nailing in grade 3 femoral fractures as an early method of definitive fixation is an effective option. In such cases, optimizing controllable variables like surgical expertise and adequate antibiotic prophylaxis can improve outcomes.