title: Complications after intramedullary nailing of femoral fractures in a low-income country.
abstract: BACKGROUND
  Some 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.
  
  
  METHODS
  137 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.
  
  
  RESULTS
  79 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).
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen.
authors.forename: Sven
authors.initials: S
authors.lastname: Young
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Banza
authors.forename: Geir
authors.initials: G
authors.lastname: Hallan
authors.forename: Fletcher
authors.initials: F
authors.lastname: Beniyasi
authors.forename: Kumbukani G
authors.initials: KG
authors.lastname: Manda
authors.forename: Boston S
authors.initials: BS
authors.lastname: Munthali
authors.forename: Eva
authors.initials: E
authors.lastname: Dybvik
authors.forename: Lars B
authors.initials: LB
authors.lastname: Engesæter
authors.forename: Leif I
authors.initials: LI
authors.lastname: Havelin
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D003906:Developing Countries; D005260:Female; D005264:Femoral Fractures / Q000401:mortality / Q000601:surgery*; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000009:adverse effects* / Q000401:mortality; D017102:Fracture Healing / Q000502:physiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000453:epidemiology*; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000601:surgery; D055815:Young Adult