Determination Of The Demographic Characteristics, Pattern, Mechanisms Of Diaphyseal Femoral Fractures And The Devices Employed In Early Immobilisation At Kenyatta National Hospital.

Abstract

Background: Fractures of the femur amongst adults are quite a common indication for admission to an orthopaedic ward. A majority are due to high energy trauma with the subsequent development of pain as a result of the fracture. A classic traction device developed by Hugh Owen Thomas in 1875 is still widely used and largely effective in stabilization of diaphyseal femoral fractures in the prehospital and early hospital setting. This is a very affordable traction device made from locally available materials. However, the proper application of the splint on the patient determines how effective the device is in terms of giving the patient pain relief and comfort whilst in transit and as they await definitive fixation. Maqungo, Roche et al in South Africa found that 37.5% of patients in a Level 1 trauma centre had the Thomas splint applied before any radiological procedure. Ayorinde in Nigeria found that no patient had received any form of first aid from the accident scene to the hospital. Objective: To describe pre-admission diaphyseal fracture femur splintage at KNH. Design: Cross sectional study. Sampling method:convenience sampling. Setting: Kenyatta National Hospital Accident & Emergency Department as well as the Orthopaedic wards. Study population: All consenting patients 18 years and above presenting at KNH Casualty department and those admitted to the orthopaedic wards with diaphyseal fracture femur.. Study period: 1st June to 31st August 2018 Methodology: All patients 18 years and above with a diaphyseal femoral fracture were recruited into the study at the point of entry into the Accident & Emergency department, KNH and in the orthopaedic wards. The type of splint applied and how the splint was applied were all noted in the data collection tool. The data collection tool also included information on patients’ biodata (coded for ethical reasons), time of injury, how injury was sustained, how the patient was transported to KNH and arrival time at KNH. Results: The most common cause of diaphyseal fracture femur was RTAs at 65.35% followed by falls at 16.53%. Pedestrians were at highest risk of femoral fractures accounting for 47% of samples. For sex distribution, 74.8% of patients were male and 25.2% female. Majority of patients had comminuted fractures. Only 26% of patients had adequate immobilization with a Thomas splint. ix Results: Young males were most likely victims of RTAs along highways sustaining comminuted fractures. Transport to hospital was mainly via ambulance with 26% having adequate immobilization with a Thomas splint done by a trained health worker. Conclusion: Provision of Thomas splints of various sizes and training of the general public in first aid interventions will go a long way in alleviating patient suffering after sustaining a femoral fracture.