ArticleActa orthopaedica2013
Complications after intramedullary nailing of femoral fractures in a low-income country.
Article in Acta orthopaedica, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed.
- Untreated surgical conditions in Malawi: A randomised cross-sectional nationwide household survey.Malawi medical journal : the journal of Medical Association of Malawi · 2017Trial
- Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia. A prospective study of 22 children (32 feet) from 2 to 10 years of age.Acta orthopaedica · 2014Trial
- Randomized controlled trial to compare functional outcomes between Locking compression Plates and Retrograde Intramedullary Nails in distal femur fractures.Pakistan journal of medical sciences · 2026Article
- Predictors of complications after intramedullary nailing for lower extremity fractures in low-resource settings: a 10-year experience with the SIGN nail in Nigeria.Patient safety in surgery · 2025Article
- Review
- Outcomes of intramedullary nailing for traumatic adult femoral shaft fractures in low-and-middle-income countries; a systematic review.OTA international : the open access journal of orthopaedic trauma · 2025Article
- Prevalence of infection and associated factors after intramedullary nailing in African countries with the Surgical Implant Generation Network program: A systematic review and meta-analysis of available evidence.SAGE open medicine · 2025Review
- A Systematic Review of the Incidence and Pattern of Surgical Site Infection in Orthopedic Surgery in Africa.Cureus · 2024Review
- Follow-up non-attendance after long-bone fractures in a low-resource setting: a prospective study of predictors and interventions to increase attendance rates.BMC health services research · 2023Article
- Outcomes after primary intramedullary nail fixation of open tibial and femoral fractures in low resource settings.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Management of Traumatic Femur Fractures: A Focus on the Time to Intramedullary Nailing and Clinical Outcomes.Diagnostics (Basel, Switzerland) · 2023Article
- Infection complicating locked intramedullary nailing of open lower-extremity fractures: incidence, associated risk factors, and lessons for improving outcome in a low-resource setting.Journal of bone and joint infection · 2023Article
- Prevalence and associated factors of infection after intramedullary nailing of long bone fractures among patients attending St. Paul's Hospital Millennium Medical College, AaBET Hospital, Addis Ababa, Ethiopia.SAGE open medicine · 2023Article
- Telemedicine in Surgical Care in Low- and Middle-Income Countries: A Scoping Review.World journal of surgery · 2022Article
- Management of fracture-related infection in low resource settings: how applicable are the current consensus guidelines?EFORT open reviews · 2022Review
- Intramedullary nail for the surgical treatment of unstable fractures of the femur in previously amputated patientsRevista de la Facultad de Ciencias Medicas (Cordoba, Argentina) · 2021Article
- Functional outcome of patients of tibial fracture treated with solid nail (SIGN nail) versus conventional hollow nail - A randomized trial.Journal of clinical orthopaedics and trauma · 2021Article
- Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi.Acta orthopaedica · 2020Observational
- The Impact of EBM-Manufactured Ti6Al4V ELI Alloy Surface Modifications on Cytotoxicity toward Eukaryotic Cells and Microbial Biofilm Formation.Materials (Basel, Switzerland) · 2020Article
- Travel barriers, unemployment, and external fixation predict loss to follow-up after surgical management of lower extremity fractures in Dar es Salaam, Tanzania.OTA international : the open access journal of orthopaedic trauma · 2020Article
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSome surgeons believe that internal fixation of fractures carries too high a risk of infection in low-income countries (LICs) to merit its use there. However, there have been too few studies from LICs with sufficient follow-up to support this belief. We first wanted to determine whether complete follow-up could be achieved in an LIC, and secondly, we wanted to find the true microbial infection rate at our hospital and to examine the influence of HIV infection and lack of follow-up on outcomes. PATIENTS AND
methods137 patients with 141 femoral fractures that were treated with intramedullary (IM) nailing were included. We compared outcomes in patients who returned for scheduled follow-up and patients who did not return but who could be contacted by phone or visited in their home village.
results79 patients returned for follow-up as scheduled; 29 of the remaining patients were reached by phone or outreach visits, giving a total follow-up rate of 79%. 7 patients (5%) had a deep postoperative infection. All of them returned for scheduled follow-up. There were no infections in patients who did not return for follow-up, as compared to 8 of 83 nails in the group that did return as scheduled (p = 0.1). 2 deaths occurred in HIV-positive patients (2/23), while no HIV-negative patients (0/105) died less than 30 days after surgery (p = 0.03).
interpretationWe found an acceptable infection rate. The risk of infection should not be used as an argument against IM nailing of femoral fractures in LICs. Many patients in Malawi did not return for follow-up because they had no complaints concerning the fracture. There was an increased postoperative mortality rate in HIV-positive patients.
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