Outcome at 1 year in patients with femoral shaft fractures treated with intramedullary nailing or skeletal traction in a low-income country: a prospective observational study of 187 patients in Malawi

Figures & data

Figure 1. Flow chart showing eligibility, exclusion, enrolment and loss to follow-up of patients.

Table 1. Baseline details

Variable	IM nailing n = 55	All skeletal traction n = 132	p	Convert n = 40	Successful traction only n = 92
Age, mean (SD)	38 (13)	40 (16)	0.3	37 (14)	41 (17)
median	37	37 (
IQR	28–45	26–48
Sex, n (%)			0.7
Female	12	22 (17)		6	16
Male	42	107 (81)		33	74
Missing	1	3 (2)		1	2
Marital status			0.8
Single	16	39 (30)		10	29
Married	36	79 (60)		26	53
Divorced/separated	1	5 (3.8)		2	3
Widow/widower	2	7 (5)		1	6
Missing	0	2 (2)		1	1
Education			< 0.001
Primary	13	76 (58)		16	60
Secondary	18	40 (30)		18	22
Post-secondary	22	12 (9)		5	7
Missing	0	4 (3)		1	3
Mechanism of injury			0.4
Fall	13	45 (34)		12	33
RTI	37	68 (52)		24	44
Other	4	16 (12)		2	14
Missing	1	3 (2)		2	1
Smoking			0.3
No	52	112 (85)		33	79
Yes	2	13 (10)		4	9
Missing	1	7 (5)		3	4
OTA classification			0.02
A (simple)	37	97 (74)		31	66
B (wedge)	13	15 (11)		5	10
C (complex)	4	5 (4)		1	4
Missing	1	15 (11)		3	12
OTA 32A subclass			0.06
Oblique	10	11 (8)		4	7
Spiral	6	16 (12)		7	9
Transverse	18	67 (51)		20	47
Missing	21	38 (29)		9	29
Location			0.4
Distal zone	3	16 (12)		6	10
Middle zone	35	82 (62)		27	55
Subtrochanteric	9	14 (11)		3	11
Missing	8	20 (15)		4	16
Side of injury			0.7
Right	29	70 (53)		22	48
Left	23	53 (40)		14	39
Missing	3	9 (7)		4	5
Duration before treatment		< 0.001
mean (SD)	13 (12)	4.4 (5)		6 (6)	5 (12)
median	10	3		3	3
IQR	3–18	1–6		1–8	1–5

Figure 2. Unadjusted mean EQ-5D scores for IM nailing vs. skeletal traction.

Table 2. Unadjusted results for sub-group analysis. Values are mean (CI)

Variable	Pre-injury/baseline	6 weeks	3 months	6 months	1 year
EQ-5D
Successful ST	0.99 (0.98–1)	0.40 (0.31–0.49)	0.64 (0.50–0.73)	0.80 (0.74–0.86)	0.91 (0.88–0.93)
IMN	0.95 (0.92–0.99)	0.50 (0.42–0.59)	0.72 (0.68–0.77)	0.85 (0.78–0.91)	0.91 (0.87–0.95)
SMFA FI
Successful ST	1.5 (1.0–2.0)	52 (48–57) ^a	36 (29–42) ^a	23 (18–28) ^a	6.7 (4.9– 8.5)
IMN	2.5 (0.8–4.1)	43 (38–47)	27 (23–31)	16 (11–20)	9.3 (5.7–13)
SMFA BI
Successful ST	0 (	48 (43–54) ^a	30 (24–37)	18 (13–23)	6.3 (4.1–8.4)
IMN	1 (–0.4 to 2)	39 (34–44)	24 (19–29)	13 (7.9–18)	7.6 (3.6–12)

^a statistically significant (p < 0.05)

SMFA FI, SMFA Function Index. SMFA BI, SMFA Bothersome Index

Table 3. Adjusted results

Variable	Pre-injury/baseline coefficient (CI)	6 weeks coefficient (CI)	3 months coefficient (CI)	6 months coefficient (CI)	1 year coefficient (CI)
ST vs. IMN
EQ5D score	0.03 (–0.004 to 0.1)	–0.14 (–0.27 to –0.02)	–0.07 (–0.14 to –0.0001)	–0.08 (–0.15 to –0.01)	0.001 (–0.05 to 0.05)
p-value	(0.1	(0.03	(0.05	(0.04	(1
SMFA FI	–1.0 (–2.5 to 0.6)	8.7 (2.6 to 15)	8.4 (2.6 to 14)	7.9 (1.7 to 14)	–2. (–5.8 to 1.7)
p-value	(0.2	(0.01	(0.01	(0.01	(0.3
SMFA BI	–0.5 (–1.9 to 0.9)	9.2 (2.4 to 16)	7.7 (1.2 to 14)	6.7 (–0.3 to 14)	–1.2 (–5.4 to 2.9)
p-value	(0.5	(0.01	(0.02	(0.1	(0.6
IMN vs. successful ST
EQ5D score	0.03 (–0.002 to 0.1)	–0.09 (–0.2 to 0.06)	–0.07(–0.2 to 0.03)	–0.05 (–0.14 to 0.03)	–0.0001 (–0.05 to 0.05)
p-value	(0.1	(0.2	(0.2	(0.2	(1
SMFA FI	–1.1 (–2.6 to 0.5)	8.5 (1.8 to 15)	7.6 (0.4 to 15)	7.2 (0.4 to 14)	–2.4 (–6.3 to 1.5)
p-value	(0.2	(0.01	(0.04	(0.04	(0.2
SMFA BI	–0.9 (–2.2 to 0.4)	8.8 (0.9 to 17)	5.5 (–2.5 to 14)	4.1(–3.6 to 12)	–1.2 (–5.6 to 3.1)
p-value	(0.2	(0.03	(0.2	(0.3	(0.6

Figure 3. Unadjusted mean SMFA Functional Index scores for IM nailing vs. skeletal traction.

Figure 4. Unadjusted mean SMFA Bothersome Index for IM nailing vs. skeletal traction.