Abstract
Background
The utilisation and consequences of standardised operative procedures may importantly
differ between different healthcare systems. This is the first investigation comparing
the treatment and outcome of femoral shaft fractures stabilised with an identical
implant between trauma centres in 2 continents (Europe, EU and South Africa, SA).
Methods
Following standardised introduction of the technique, the prospective, observational
multicentre study enrolled 175 patients who underwent intramedullary fracture fixation
using the antegrade femoral nail (AFN) for femoral shaft fractures. Eleven EU hospitals
recruited 86 patients and 1 SA centre 89 patients in the study period. Comparison
of epidemiologic data, operative characteristics as well as subjective (e.g., pain,
SF-36) and objective (e.g., X-ray, range of motion [ROM]) 3-month and 1-year outcomes
were performed (p < 0.05).
Results
Compared to EU centres, several significant differences were observed in SA: (1) on
average, patients operated on were younger, had less concomitant diseases and had
more severe open fractures; (2) operative stabilisation was more often undertaken
by young, unsupervised residents, with shorter operating and intraoperative fluoroscopy
times; (3) mean hospital stay was shorter, with less recorded complications, but a
higher loss to follow-up rate. Non- or malunion rates and subjective outcomes were
similar for both groups, with the physical component of the SF-36 at the 1-year follow-up
not fully restoring to baseline values.
Conclusions
Our investigation demonstrates the importance of several major differences between
2 different regions of the world in the treatment of femoral shaft fractures, despite
involving only high level trauma centres and using an identical implant. The intercontinental
comparison of results from clinical studies should be interpreted very carefully considering
the heterogeneity of populations and clinical settings.
Keywords
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Article info
Publication history
Accepted:
October 12,
2009
Identification
Copyright
© 2009 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
