Predictors of complications after intramedullary nailing for lower extremity fractures in low-resource settings: a 10-year experience with the SIGN nail in Nigeria.

backgroundIn low-resource countries, the incidence of lower extremity long-bone fractures exceeds that in high-resource countries due to higher rates of motor vehicle collisions (MVCs). This situation is worsened by limited resources for adequate care, resulting in significant health and economic impacts. Locked intramedullary nailing (IMN) is a widely accepted treatment for lower extremity fractures, but it carries risks of complications, which have not been well-studied in low-resource settings. Considering the resource differences between high- and low-resource settings, local research is essential for identifying modifiable factors to prevent complications. This study investigated the predictors of complications after IMN with "Surgical Implant Generation Network" (SIGN) nails (Richland, WA, USA) for lower extremity fractures in a low-resource setting.

methodsA secondary analysis was performed on prospectively collected data from 666 fractures in 603 patients treated with SIGN nails at a mission teaching hospital in southwestern Nigeria between July 2014 and June 2024. The mean age was 43.2 years, and 65.7% of the patients were male. Fractures meeting the inclusion criteria were classified as with or without complications. Two-thirds (66.8%) were femur fractures, and 33. 2% were tibia fractures. Univariate and binary logistic regression analyses identified significant predictors of complications.

resultsThe overall complication rate was 11.7%, with infection and non- union being the most common. The mortality rate was 1.1%. Independent predictors of complications included injury mechanism (p = 0.033), fracture age (p = 0.003), fracture type (p < 0.001), prior treatment elsewhere (p = 0.007), and surgery duration (p = 0.004). Fractures resulting from MVCs, older fractures, and open fractures showed higher complication rates. Each additional 30 min of surgery increased the odds of complications by 34% (95% CI, 1.003-1.017).

conclusionThis study shows that IMN with SIGN nails is an effective treatment for fractures in low-resource settings. However, challenges remain, especially with open fractures and delayed treatment. Prioritizing timely surgery, improving infection control, and enhancing surgical efficiency are essential for better outcomes. The findings inform strategies for improvement and highlight the need for further research to develop evidence-based guidelines for IMN in low-resource environments.