The Use of Modular Distal Aiming Device (MODAD) System for Locked Intra-medullary Nailing for Fixation of Fractures in Nigeria: A Prospective Observational Study

Locked intra medullary nailing has been accepted globally as the gold standard for treating fractures of the shaft of long bones. The method provides acceptable stabilisation of the fracture, controls alignment, axial translation and rotational deformity at the fracture. The challenges of closed locked intra medullary nailing of fractures include the availability of resources such as operation equipment, skilled manpower required for such practice as well as the risk of irradiation exposure from the use of Image intensifier for the procedure. To obviate these challenges, option to achieve locked intra medullary nailing of fractures using various devices have been developed including the modular distal aiming device.

Aim: The aim of this study is to evaluate the early experience with the use of the modular distal aiming device for locked intra medullary nailing in various hospitals across Nigeria.

Methods: Evaluation of prospectively collected data of patients with long bone diaphyseal fractures treated with Synthes modular distal aiming device between January 1, 2007 and May 15, 2014 in various hospitals across Nigeria. Data was analysed and results are presented and discussed.

Results: During the period under study, 71 fractures were treated with the device in various hospitals across the country with the majority (54 {76%}) of the fractures treated at Teme Hospital Port Harcourt, Nigeria. Most of the fractures resulted from Road Traffic Crashes. The median total duration of surgery was 1 hour 54 minutes (IQR, 40 mins – 4 hour 10 mins) whereas the median time to locking distal holes was 47 mins (IQR, 25 – 2 hour 25 mins). The total average estimated intra-operative blood loss (including fracture haematoma) was 452 mls ±128 mls) requiring blood transfusion of 25 units of blood for all patients. The post operative infection rate was 5 (7%) including superficial infection, deep infection and overt chronic osteomyelitis.

Conclusion: Modular distal aiming device is a good tool for locked intra medullary nailing of long bone fractures. It obviate the huge cost of acquiring and maintaining C arm required for closed locked intra medullary nailing of fractures of the shaft of long bone. The results from the use of such distal aiming device compared favourably with those obtained from the use of C-arm from other centres and eliminated the exposure to irradiation associated with the use of C-arms.