Observational studyActa orthopaedica2020
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.
Observational study in Acta orthopaedica, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 17 citations in OpenAlex.
- Treatment Trade-Offs and Choices for Femoral Fractures: A Systematic Review and Meta-Analysis.Orthopaedic surgery · 2025Pooled it
- Cost-effectiveness of surgical and conservative interventions for orthopaedic injuries in Malawi: a modelling study.BMJ global health · 2026Article
- 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
- Nomogram Development and Feature Selection Strategy Comparison for Predicting Surgical Site Infection After Lower Extremity Fracture Surgery.Medicina (Kaunas, Lithuania) · 2025Article
- Is fracture management merely a physical process? Exploring the psychological effects of internal and external fixation.Journal of orthopaedic surgery and research · 2024Article
- Functional outcomes and quality of life at 1-year follow-up after an open tibia fracture in Malawi: a multicentre, prospective cohort study.The Lancet. Global health · 2023Article
- The Socioeconomic consequences of femoral shaft fracture for patients in Malawi.Malawi medical journal : the journal of Medical Association of Malawi · 2023Article
- Cost utility analysis of intramedullary nailing and skeletal traction treatment for patients with femoral shaft fractures in Malawi.Acta orthopaedica · 2021Article
- Protocol for a prospective cohort study of open tibia fractures in Malawi with a nested implementation of open fracture guidelines.Wellcome open research · 2021Article
- Article
- Do Open Fracture Classification Systems Predict Functional Outcomes in a Low-Income Country?: A Prospective Study of 287 People with Open Tibia Fractures in Malawi.JB & JS open accessArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background and purpose - Intramedullary nailing (IMN) is underutilized in low-income countries (LICs) where skeletal traction (ST) remains the standard of care for femoral shaft fractures. This prospective study compared patient-reported quality of life and functional status after femoral shaft fractures treated with IMN or ST in Malawi. Patients and methods - Adult patients with femoral shaft fractures managed by IMN or ST were enrolled prospectively from 6 hospitals. Quality of life and functional status were assessed using EQ-5D-3L, and the Short Musculoskeletal Function Assessment (SMFA) respectively. Patients were followed up at 6 weeks, 3, 6, and 12 months post-injury. Results - Of 248 patients enrolled (85 IMN, 163 ST), 187 (75%) completed 1-year follow-up (55 IMN, 132 ST). 1 of 55 IMN cases had nonunion compared with 40 of 132 ST cases that failed treatment and converted to IMN (p < 0.001). Quality of life and SMFA Functional Index Scores were better for IMN than ST at 6 weeks, 3 and 6 months, but not at 1 year. At 6 months, 24 of 51 patients in the ST group had returned to work, compared with 26 of 37 in the IMN group (p = 0.02). Interpretation - Treatment with IMN improved early quality of life and function and allowed patients to return to work earlier compared with treatment with ST. Approximately one-third of patients treated with ST failed treatment and were converted to IMN.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.